Worker Information - Terms and Conditions of Employment

Disclosures to Workers Under the Migrant and Seasonal Agricultural Worker Protection Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0002 can be found here:

Documents and Forms

Document Name Document Type
Form WH-516 English Worker Information - Terms and Conditions of Employment Form
WH-516 English Worker Information-Terms and Conditions of Employment WH-516 1-28-14.pdf www.dol.gov/whd/forms/wh516.pdf Form
WH-516 Spanish Informacion Sobre el Obrero-Terminos y Condiciones de Em WH-516_Spanish 1-28-14.pdf www.dol.gov/whd/forms/WH-516_Spanish.pdf Form
WH-516 Haitian Cre Lwa sou Pwoteksyon Travaye Agrikol Migran epi Tanpore WH-516_HaitianCreole 1-28-14.pdf www.dol.gov/whd/forms/WH516HaitianCreole.pdf Form

Information Collection (IC) Details

IC Title:	Worker Information - Terms and Conditions of Employment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.75 29 CFR 500.76

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-516 English	Worker Information-Terms and Conditions of Employment	WH-516 1-28-14.pdf	http://www.dol.gov/whd/forms/wh516.pdf	Yes	No	Fillable Printable
Form	WH-516 Spanish	Informacion Sobre el Obrero-Terminos y Condiciones de Empleo	WH-516_Spanish 1-28-14.pdf	http://www.dol.gov/whd/forms/WH-516_Spanish.pdf	Yes	No	Fillable Printable
Form	WH-516 Haitian Creole	Lwa sou Pwoteksyon Travaye Agrikol Migran epi Tanpore	WH-516_HaitianCreole 1-28-14.pdf	http://www.dol.gov/whd/forms/WH516HaitianCreole.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 105,587	Number of Respondents for Small Entity: 100,000

Affected Public: Private Sector	Private Sector: Farms, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,639,675	-45,685	2,685,360
Annual IC Time Burden (Hours)	57,193	-1,087	58,280
Annual IC Cost Burden (Dollars)	105,134	-2,280	107,414

Documents for IC

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.