Information Collection

Form ETA-9165 Requirements

IC 255327 under ICR 202408-1205-004 · OMB 1205-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0508 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9165 Form ETA-9165 Requirements	Form
Form ETA 9165 Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OEWS Survey Form ETA-9165 Requirements	Form
Form ETA-9165 Instructions 1205-0508 Cleaned.docx	Instruction
Form ETA-9165 Instructions 1205-0508 Cleaned.docx	Instruction
ETA 9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165 1205-0508 Cleaned.docx	Form
ETA 9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165 1205-0508 Cleaned.docx	Form
Form ETA-9165 1205-0508 Tracked.docx 9165 Tracked	IC Document
Form ETA-9165 1205-0508 Tracked.docx 9165 Tracked	IC Document
Form ETA-9165 Instructions 1205-0508 Tracked.docx 9165 Instructions Tracked	IC Document
Form ETA-9165 Instructions 1205-0508 Tracked.docx 9165 Instructions Tracked	IC Document

IC Title:

Form ETA-9165 Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 214.2(h) 20 CFR 655

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
Form	ETA 9165				Yes	Yes	Fillable Fileable
Instruction					Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/ETA-7

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, Not-for-profit institutions, Farms

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-278	278
Annual IC Time Burden (Hours)	-117	117
Annual IC Cost Burden (Dollars)	-213,953	213,953

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
9165 Tracked		08/16/2022
9165 Instructions Tracked		08/16/2022

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

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