Information Collection

Form ETA-9165 Requirements

IC 255327 under ICR 202602-1205-002 · OMB 1205-0508.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
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
ETA-9165 General Instructions.docx	Instruction
ETA 9165 Employer-Provided Survey Attestations to Accompany H-2B Form ETA-9165.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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: 179

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	179	-99	278
Annual IC Time Burden (Hours)	75	-42	117
Annual IC Cost Burden (Dollars)	188,938	-25,015	213,953

Documents for IC

table that charts IC Documents
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.

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