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⚠️ Notice: This information collection may be referencing outdated material.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 Instructions 1205-0508 Cleaned.docx	Instruction
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 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	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

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: Farms, Not-for-profit institutions, Businesses or other for-profits

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	Form ETA-9165 1205-0508 Tracked.docx	08/16/2022
9165 Instructions Tracked	Form ETA-9165 Instructions 1205-0508 Tracked.docx	08/16/2022

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