Information Collection

Application for Prevailing Wage Determination

IC 235476 under ICR 202602-1205-004 · OMB 1205-0534.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9141C Application for Prevailing Wage Determination Application for Prevailing Wage Determination	Form
OSEC Approved 03. Form ETA-9141C General Instructions (4.16.26).docx	Instruction
ETA-9141C Application for Prevailing Wage Determination OSEC Approved 04. Form ETA-9141C Application PWD (4.16.26).docx	Form
Form_ETA_9141C_PWD_CasePrepView Screenshots.docx Form 9141C Screenshots	IC Document

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: 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-9141C				Yes	Yes	Fillable Fileable
Instruction					Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 722

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,210	-11,748	16,958
Annual IC Time Burden (Hours)	2,449	-5,524	7,973
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form 9141C Screenshots		09/08/2021

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

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