Information Collection

H-2B Employer-Provided Survey Attestation

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.