Information Collection

H-2B Employer-Provided Survey Attestation

IC 232986 under ICR 201812-1205-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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.pdf	Instruction
ETA-9165 Employer-Provided Survey Attestations to Accompany H-2B FORM ETA 9165.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: 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.pdf		Yes	Yes	Fillable Fileable
Instruction			Form ETA-9165 Instructions.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	Previously Approved
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.