Form ETA-9165 Requirements

Application for Prevailing Wage Determination

OMB: 1205-0508

IC ID: 255327

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Form ETA-9165 Requirements
 
No New
 
Required to Obtain or Retain Benefits
 
8 CFR 214.2(h) 20 CFR 655

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-OEWS Survey Form ETA-9165 1205-0508 Cleaned.docx Yes Yes Fillable Fileable
Instruction Form ETA-9165 Instructions 1205-0508 Cleaned.docx Yes Yes Fillable Fileable

Workforce Management Training and Employment

DOL/ETA-7  87 FR 8292

278 0
   
Private Sector Farms, Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 278 0 278 0 0 0
Annual IC Time Burden (Hours) 117 0 117 0 0 0
Annual IC Cost Burden (Dollars) 213,953 0 213,953 0 0 0

Title Document Date Uploaded
9165 Tracked Form ETA-9165 1205-0508 Tracked.docx 08/16/2022
9165 Instructions Tracked Form ETA-9165 Instructions 1205-0508 Tracked.docx 08/16/2022
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