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Housing Terms and Conditions for Migrant Agricultural Workers
Disclosures to Workers Under the Migrant and Seasonal Agricultural Worker Protection Act
OMB: 1235-0002
IC ID: 195676
OMB.report
DOL/WHD
OMB 1235-0002
ICR 202001-1235-002
IC 195676
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0002 can be found here:
2023-08-09 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form WH-521 English/Spa
Housing Terms and Conditions for Migrant Agricultural Workers
Form and Instruction
WH-521 English/Spa Housing Terms and Conditions
WH-521 20200622 ES.docx
www.dol.gov/agencies/whd/forms
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
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 and Instruction
WH-521 English/Spanish
Housing Terms and Conditions
WH-521 20200622 ES.docx
https://www.dol.gov/agencies/whd/forms
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:
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
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
1,300
0
0
0
0
1,300
Annual IC Time Burden (Hours)
650
0
0
0
0
650
Annual IC Cost Burden (Dollars)
52
0
0
0
0
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.