Information Collection

Housing Terms and Conditions

IC 13820 under ICR 201003-1235-010 · OMB 1235-0010.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-521 Housing Terms and Conditions	Form
WH-521 Housing Terms and Conditions wh521.pdf www.dol.gov/esa/forms/whd/wh521.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 500.1

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-521	Housing Terms and Conditions	wh521.pdf	http://www.dol.gov/esa/forms/whd/wh521.pdf	No		Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	650	650
Annual IC Cost Burden (Dollars)	0	0

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.