Information Collection

H-2B Employer-Provided Survey Attestation

IC 215966 under ICR 201510-1205-006 · OMB 1205-0516.

Documents and Forms

Document Name Document Type
Form ETA-9165 H-2B Employer-Provided Survey Attestation Form
Form ETA-9165 Instructions - clean.docx Instruction
ETA-9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165 clean.docx Form
Appropriation Act Riders.pdf Consolidated Appropriations Act, 2016 Excerpts for OFLC 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: Modified

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
Form	ETA-9165	Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey	Form ETA-9165 clean.docx		Yes	No	Fillable Printable
Instruction			Form ETA-9165 Instructions - clean.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 278	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	278	-278	556
Annual IC Time Burden (Hours)	116	-232	348
Annual IC Cost Burden (Dollars)	217,523	5,639	211,884

Documents for IC

Title	Document	Date Uploaded
Consolidated Appropriations Act, 2016 Excerpts for OFLC	Appropriation Act Riders.pdf	12/30/2015

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