Information Collection

H-2B Employer-Provided Survey Attestation

IC 232986 under ICR 202204-1205-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey H-2B Employer-Provided Survey Attestation	Form
Form ETA-9165 Instructions clean 1205-0509.pdf	Instruction
Form ETA-9165 Instructions clean 1205-0509.pdf	Instruction
ETA-9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165 1205-0509 clean.pdf	Form
ETA-9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165 1205-0509 clean.pdf	Form
Form ETA-9165 Instructions 1205-0509 redlined changes.pdf Form 9165 Instructions Tracked	IC Document
Form ETA-9165 Instructions 1205-0509 redlined changes.pdf Form 9165 Instructions Tracked	IC Document
Form ETA-9165 1205-0509 redlined changes.pdf Form 9165 Tracked	IC Document
Form ETA-9165 1205-0509 redlined changes.pdf Form 9165 Tracked	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
Instruction			Form ETA-9165 Instructions clean 1205-0509.pdf		Yes	Yes	Fillable Fileable
Form	ETA-9165	Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey	Form ETA-9165 1205-0509 clean.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: Foreign Labor Certification System and Employer Application Case Files

FR Citation: 87 FR 8292

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	278	0	278
Annual IC Time Burden (Hours)	117	1	116
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form 9165 Instructions Tracked	Form ETA-9165 Instructions 1205-0509 redlined changes.pdf	05/17/2022
Form 9165 Tracked	Form ETA-9165 1205-0509 redlined changes.pdf	05/17/2022

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