Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
H-2B Employer-Provided Survey Attestation
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 655.10
8 CFR 214.2(h)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
1205-0NEW_GENERAL INSRTUCTIONS_ETA Form 9165_FInal 04-24-2015.docx
Yes
No
Printable Only
Form
ETA-9165
Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey
1205-0NEW_ETA Form 9165_Final 04-24-2015.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
556
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Farms
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
556
0
556
0
0
0
Annual IC Time Burden (Hours)
348
0
348
0
0
0
Annual IC Cost Burden (Dollars)
211,884
0
211,884
0
0
0
Documents for IC
Title
Document
Date Uploaded
Memo Requesting Emergency Processing from Assistant Secretary Portia Wu
OMB memo requesting emergency processing.pdf
04/03/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.