Form ETA-790A Adde Additional Place of Employment Information

O MB Approval: 1205-0466

Expiration Date: XX/XX/XXXX

H-2A Agricultural Clearance Order

Form ETA-790A Addendum B

U.S. Department of Labor

C. Additional Place of Employment Information

1. Name of Agricultural Business §	2. Place of Employment *	3. Additional Place of Employment Information §	4. Begin Date §	5. End Date §	6. Total Workers §

D. Additional Housing Information

1. Type of Housing *	2. Physical Location *	3. Additional Housing Information §	4. Total Units *	5. Total Occupancy *	6. Inspection Entity *
 Employer-provided  Rental or public accommodations					 Local authority  SWA  Other State authority  Federal authority  Other _______________
 Employer-provided  Rental or public accommodations					 Local authority  SWA  Other State authority  Federal authority  Other _______________
 Employer-provided  Rental or public accommodations					 Local authority  SWA  Other State authority  Federal authority  Other _______________
 Employer-provided  Rental or public accommodations					 Local authority  SWA  Other State authority  Federal authority  Other _______________
 Employer-provided  Rental or public accommodations					 Local authority  SWA  Other State authority  Federal authority  Other _______________

For Public Burden Statement, see the Instructions for Form ETA-790/790A.

Form ETA-790A Addendum B FOR DEPARTMENT OF LABOR USE ONLY Page B.1 of B.2

H-2A Case Number: ____________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________