Worker Information - Terms and Conditions of Employment

Forms and Documents

Document Name	Status
Form WH-516-ENGLISH Worker Information - Terms and Conditions of Employment Form	Modified
SS for 1215-0187(2007).doc Supporting Statement A	2007-12-05

IC Document Collections

IC ID	Document Title	Status
13905	Worker Information - Terms and Conditions of Employment Form	Modified

ICR Details

OMB Control No: 1215-0187	ICR Reference No: 200707-1215-005
Status: Historical Active	Previous ICR Reference No: 200412-1215-002
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Worker Information - Terms and Conditions of Employment
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/06/2008
	Date Received in OIRA: 12/21/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	36 Months From Approved	02/29/2008
Responses	3,102,000	0	1,594,800
Time Burden (Hours)	77,550	0	68,800
Cost Burden (Dollars)	93,060	0	43,000

---

Abstract: Agricultural employers and associations and farm labor contractors may use this form to disclose employment terms and conditions to migrant/seasonal agricultural workers, to comply with the Migrant Seasonal Agricultural Worker Protection Act.

---

Authorizing Statute(s): US Code: 29 USC 1801, et seq. Name of Law: Migrant and Seasonal Agricultural Worker Protection Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 52166	09/12/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 72760	12/21/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Worker Information - Terms and Conditions of Employment	WH-516-ENGLISH, WH-516-ESPANOL	Worker Information-Terms and Conditions of Employment ,   Informacion Sobre el Trabajador-Terminos y Condiciones de Empleo

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,102,000	1,594,800	0	0	1,507,200	0
Annual Time Burden (Hours)	77,550	68,800	0	0	8,750	0
Annual Cost Burden (Dollars)	93,060	43,000	0	0	50,060	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a 8750 burden hours increase to respondents (from 68,800 hours to 77,550 hours), because of the increased estimated responses (from 1,594,800 responses to 3,102,000 responses). The increase for estimated responses increases the total respondent operation and maintenance costs by $50,060.00 (from $43,060.00 to $93,060.00).

---

Annual Cost to Federal Government: $60,748

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/21/2007

---