ETA-790A Addendum Form ETA-790A Addendum B

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

H-2A Agricultural Clearance Order
Form ETA-790A Addendum B
U.S. Department of Labor
C. Additional Place of Employment Information
1. Name of Agricultural Business §

Form ETA-790A Addendum B
H-2A Case Number: ____________________

3. Additional Place of Employment Information §

2. Place of Employment *

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

4. Begin
Date §

5. End
Date §

6. Total
Workers §

Page B.1 of B.2
Validity Period: _____________ to _____________

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

H-2A Agricultural Clearance Order
Form ETA-790A Addendum B
U.S. Department of Labor
D. Additional Housing Information
1. Type of Housing *

3. Additional Housing Information §

2. Physical Location *

4. Total
Units *

5. Total
Occupancy *

6. Applicable
Housing
Standards *

 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal
 Local
 State
 Federal

Form ETA-790A Addendum B
H-2A Case Number: ____________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

Page B.2 of B.2
Validity Period: _____________ to _____________