Form ETA-790A Adde Additional Place of Employment Information

H-2A Temporary Agricultural Labor Certification Program

NPRM_09b_ETA-790A_Addendum_B_clean

OMB: 1205-0466

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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 Agricultural Business Information



Ag Business 1

1. Ag Business ID *

2. FEIN (from IRS) *

3. Legal Business Name *

4. Trade Name/Doing Business As (DBA), if applicable §

5. Previous DBA, if applicable §

6. Previous DBA, if applicable §

7. Address 1 *

8. Address 2 (suite/floor and number) §

9. City *

10. State *


11. Postal code *

12. County *



Ag Business 2

1. Ag Business ID *

2. FEIN (from IRS) *

3. Legal Business Name *

4. Trade Name/Doing Business As (DBA), if applicable §

5. Previous DBA, if applicable §

6. Previous DBA, if applicable §

7. Address 1 *

8. Address 2 (suite/floor and number) §

9. City *

10. State *


11. Postal code *

12. County *



Ag Business 3

1. Ag Business ID *

2. FEIN (from IRS) *

3. Legal Business Name *

4. Trade Name/Doing Business As (DBA), if applicable §

5. Previous DBA, if applicable §

6. Previous DBA, if applicable §

7. Address 1 *

8. Address 2 (suite/floor and number) §

9. City *

10. State *


11. Postal code *

12. County *



D. Additional Place of Employment Information



1. Ag Business ID *

2. Place of Employment *

3. Additional Place of Employment Information §

4. Begin Date §

5. End Date §

6. Total Workers §


  1. Address 1





  1. Address 2 (suite/floor and number) §

  1. City

  1. State

  1. Postal Code

  1. County


  1. Address 1





  1. Address 2 (suite/floor and number) §

  1. City

  1. State

  1. Postal Code

  1. County


  1. Address 1





  1. Address 2 (suite/floor and number) §

c. City

d. State

e. Postal Code

f. County


  1. Address 1





  1. Address 2 (suite/floor and number) §

c. City

d. State

e. Postal Code

f. County


  1. Address 1





  1. Address 2 (suite/floor and number) §

c. City

d. State

e. Postal Code

f. County







E. 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.3


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

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMelanie Shay
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File Created2024-07-31

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