Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions

Records to be kept by Employers- Fair Labor Standards Act (FLSA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0030 can be found here:

Documents and Forms

Document Name Document Type
Form WH-5 Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions Form and Instruction
WH-5 Certificate of Training WH-5.pdf www.dol.gov/whd/forms/WH-5.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 570.72

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-5	Certificate of Training	WH-5.pdf	https://www.dol.gov/whd/forms/WH-5.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,150	Number of Respondents for Small Entity: 9,000

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	20,200	20,200
Annual IC Time Burden (Hours)	337	337
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.