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H-2B Employer-Provided Survey Attestation
H-2B Foreign Labor Certification Program
OMB: 1205-0509
IC ID: 232986
OMB.report
DOL/ETA
OMB 1205-0509
ICR 201805-1205-002
IC 232986
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0509 can be found here:
2022-05-23 - Revision of a currently approved collection
2019-01-31 - Revision of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
278
0
278
0
0
0
Annual IC Time Burden (Hours)
116
0
116
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.