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⚠️ Notice: This information collection may be referencing outdated material.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

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_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

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:

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_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 %

table that charts list of burden
	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

table that charts IC Documents
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.