Information Collection

Worker Information - Terms and Conditions of Employment

IC 13905 under ICR 200707-1215-005 · OMB 1215-0187.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-516-ENGLISH Worker Information-Terms and Conditions of Employment Worker Information - Terms and Conditions of Employment	Form
Form WH-516-ESPANOL Informacion Sobre el Trabajador-Terminos y Condiciones de Empleo Worker Information - Terms and Conditions of Employment	Form
WH-516-ENGLISH Worker Information-Terms and Conditions of Employment Form_WH-516_English.pdf www.dol.gov/esa/forms/whd/Form_WH-516_English.PDF	Form
WH-516-ESPANOL Informacion Sobre el Trabajador-Terminos y Condiciones d WH-516_Spanish.pdf www.dol.gov/esa/forms/whd/WH-516_Spanish.PDF	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.75 29 CFR 500.76

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-516-ENGLISH			http://www.dol.gov/esa/forms/whd/Form_WH-516_English.PDF	Yes	No	Fillable Printable
Form	WH-516-ESPANOL			http://www.dol.gov/esa/forms/whd/WH-516_Spanish.PDF	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 129,250

Number of Respondents for Small Entity: 100,000

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,102,000	1,507,200	1,594,800
Annual IC Time Burden (Hours)	77,550	8,750	68,800
Annual IC Cost Burden (Dollars)	93,060	50,060	43,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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