Application to amend a farm labor contractor or farm labor contractor employee certificate of registration, or to request a duplicate certificate

Application for a Farm Labor Contractor or Farm Labor Contractor Employee Certificate of Registration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0016 can be found here:

Documents and Forms

Document Name Document Type
Form WH-540 Application to amend a farm labor contractor or farm labor contractor employee certificate of registration, or to request a duplicate certificate Form
Edits to Instruction Page on Website 2.16.21.docx Instruction
Edits to Instruction Page on Website 2.16.21.docx Instruction
WH-540 APPLICATION TO AMEND A FARM LABOR CONTRACTOR OR FARM LAB WH-540 - Amendment_clean.docm Form
WH-540 APPLICATION TO AMEND A FARM LABOR CONTRACTOR OR FARM LAB WH-540 - Amendment_clean.docm Form
WH-540 SOLICITUD PARA ENMENDAR UN CERTIFICADO DE REGISTRO DE CO WH-540 Amendment Form SPANISH.docm Form
WH-540 SOLICITUD PARA ENMENDAR UN CERTIFICADO DE REGISTRO DE CO WH-540 Amendment Form SPANISH.docm Form

Information Collection (IC) Details

IC Title:	Application to amend a farm labor contractor or farm labor contractor employee certificate of registration, or to request a duplicate certificate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 500.44, -.47

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-540	APPLICATION TO AMEND A FARM LABOR CONTRACTOR OR FARM LABOR CONTRACTOR EMPLOYEE CERTIFICATE OF REGISTRATION, OR TO REQUEST A DUPLICATE CERTIFICATE	WH-540 - Amendment_clean.docm	Yes	No	Fillable Printable
Form	WH-540	SOLICITUD PARA ENMENDAR UN CERTIFICADO DE REGISTRO DE CONTRATISTA DE TRABAJO AGRÍCOLA O DE EMPLEADO DE CONTRATISTA DE TRABAJO AGRÍCOLA, O PARA SOLICITAR UN CERTIFICADO DUPLICADO	WH-540 Amendment Form SPANISH.docm	Yes	No	Fillable Printable
Instruction			Edits to Instruction Page on Website 2.16.21.docx	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: ESA/DOL-34 and ESA/DOL-35	FR Citation: 67 FR 16818

Number of Respondents: 10,000	Number of Respondents for Small Entity: 9,300

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	47,940	47,940

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.