Information Collection

H-2B Employer-Provided Survey Attestation

IC 215966 under ICR 201504-1205-008 · OMB 1205-0516.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0516 can be found here:

Documents and Forms

Document Name Document Type
1205-0NEW_GENERAL INSRTUCTIONS_ETA Form 9165_FInal 04-24-2015.docx Instruction
ETA-9165 Employer-Provided Survey Attestations to Accompany H-2B 1205-0NEW_ETA Form 9165_Final 04-24-2015.docx Form
OMB memo requesting emergency processing.pdf Memo Requesting Emergency Processing from Assistant Secretary Portia Wu IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	H-2B Employer-Provided Survey Attestation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 655.10 8 CFR 214.2(h)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1205-0NEW_GENERAL INSRTUCTIONS_ETA Form 9165_FInal 04-24-2015.docx		Yes	No	Printable Only
Form	ETA-9165	Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey	1205-0NEW_ETA Form 9165_Final 04-24-2015.docx		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 556	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	556	556
Annual IC Time Burden (Hours)	348	348
Annual IC Cost Burden (Dollars)	211,884	211,884

Documents for IC

Title	Document	Date Uploaded
Memo Requesting Emergency Processing from Assistant Secretary Portia Wu	OMB memo requesting emergency processing.pdf	04/03/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.