Housing Terms and Conditions for Migrant Agricultural Workers

Disclosures to Workers Under the Migrant and Seasonal Agricultural Worker Protection Act

Documents and Forms

Document Name Document Type
Form WH-521 Housing Terms and Conditions for Migrant Agricultural Workers Form and Instruction
WH-521 Housing Terms and Conditions English/Spanish WH-521 Revised v2.0 (2023-06-15).docx www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh521.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Housing Terms and Conditions for Migrant Agricultural Workers	Agency IC Tracking Number:	200712-1215-004

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.75 29 CFR 500.1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-521	Housing Terms and Conditions English/Spanish	WH-521 Revised v2.0 (2023-06-15).docx	https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh521.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300	Number of Respondents for Small Entity: 1,274

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	650	650
Annual IC Cost Burden (Dollars)	52	52

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.