ETA 790A Addendum H-2A Agricultural Clearance Order

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

H-2A Agricultural Clearance Order
Form ETA-790A Addendum B
U.S. Department of Labor

C. Additional Place of Employment Information
1. Name of Agricultural Business §

2. Place of Employment *

3. Additional Place of Employment Information §

4. Begin
Date §

5. End
Date §

6. Total
Workers §

D. Additional Housing Information
Form ETA-790A Addendum B
H-2A Case Number: ____________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

Page B.1 of B.2
Validity Period: _____________ to _____________

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

1. Type of Housing *

H-2A Agricultural Clearance Order
Form ETA-790A Addendum B
U.S. Department of Labor
3. Additional Housing Information §

2. Physical Location *

4. Total
Units *

5. Total
Occupancy *

6. Inspection Entity *

 Local authority
 SWA
 Other State authority
 Federal authority
 Other
_______________

 Employer-provided
 Rental or public
accommodations

 Local authority
 SWA
 Other State authority
 Federal authority
 Other
_______________

 Employer-provided
 Rental or public
accommodations

 Local authority
 SWA
 Other State authority
 Federal authority
 Other
_______________

 Employer-provided
 Rental or public
accommodations

 Local authority
 SWA
 Other State authority
 Federal authority
 Other
_______________

 Employer-provided
 Rental or public
accommodations

 Local authority
 SWA
 Other State authority
 Federal authority
 Other
_______________

 Employer-provided
 Rental or public
accommodations
For Public Burden Statement, see the Instructions for Form ETA-790/790A.

Form ETA-790A Addendum B
H-2A Case Number: ____________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

Page B.2 of B.2
Validity Period: _____________ to _____________