Form ETA-9165 Requirements

Application for Prevailing Wage Determination

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form ETA 9165 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

Information Collection (IC) Details

IC Title:	Form ETA-9165 Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection 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 %

	Approved	Program Change Due to Agency Discretion
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

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.