Information Collection

H-2B Employer-Provided Survey Attestation

IC 232986 under ICR 201805-1205-002 · OMB 1205-0509.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0509 can be found here:

Documents and Forms

Document Name Document Type
Form ETA-9165 H-2B Employer-Provided Survey Attestation Form
Form ETA-9165 Instructions_FINAL 7.31.18.pdf Instruction
ETA-9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165_FINAL 7.31.18.pdf 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: 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
Form	ETA-9165	Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey	Form ETA-9165_FINAL 7.31.18.pdf		Yes	Yes	Fillable Fileable
Instruction			Form ETA-9165 Instructions_FINAL 7.31.18.pdf		Yes	Yes	Fillable Printable

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	278	278
Annual IC Time Burden (Hours)	116	116
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consolidated Appropriations Act, 2016 Excerpts for OFLC	Appropriation Act Riders.pdf	09/19/2018

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