Housing Terms and Conditions for Migrant Agricultural Workers

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⚠️ Notice: This information collection may be referencing outdated material.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-521 English and Housing Terms and Conditions for Migrant Agricultural Workers Form
WH-521 English and Housing Terms and Conditions for MSPA Workers wh521 1-28-14.pdf www.dol.gov/whd/forms/wh521.pdf Form

Information Collection (IC) Details

IC Title:	Housing Terms and Conditions for Migrant Agricultural Workers	Agency IC Tracking Number:	200712-1215-004

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 500.75 29 CFR 500.1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-521 English and Spanish	Housing Terms and Conditions for MSPA Workers	wh521 1-28-14.pdf	http://www.dol.gov/whd/forms/wh521.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: 1,300	Number of Respondents for Small Entity: 1,274

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	650	650
Annual IC Cost Burden (Dollars)	52	52

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.