ETA-790B, Addendum Non-Criteria Agricultural Clearance Order

Agricultural Recruitment System Forms Affecting Migratory Farm Workers

ETA-790B Addendum B

OMB: 1205-0134

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O MB Approval: 1205-0134

Expiration Date: XX/XX/XXXX

Non-Criteria Agricultural Clearance Order

Form ETA-790B Addendum B

U.S. Department of Labor



C. Additional Agricultural Business Information



Ag Business 1

1. FEIN (from IRS) *

2. Legal Business Name *

3. Trade Name/Doing Business As (DBA), if applicable §

4. Previous DBA, if applicable §

5. Previous DBA, if applicable §

6. Address 1 *

7. Address 2 (suite/floor and number) §

8. City *

9. State *


10. Postal code *

11. County *



Ag Business 2

1. FEIN (from IRS) *

2. Legal Business Name *

3. Trade Name/Doing Business As (DBA), if applicable §

4. Previous DBA, if applicable §

5. Previous DBA, if applicable §

6. Address 1 *

7. Address 2 (suite/floor and number) §

8. City *

9. State *


10. Postal code *

11. County *



Ag Business 3

1. FEIN (from IRS) *

2. Legal Business Name *

3. Trade Name/Doing Business As (DBA), if applicable §

4. Previous DBA, if applicable §

5. Previous DBA, if applicable §

6. Address 1 *

7. Address 2 (suite/floor and number) §

8. City *

9. State *


10. Postal code *

11. County *



D. Additional Place of Employment Information

1. Place of Employment *

2. Additional Place of Employment Information and crop and agricultural activity *

3. Begin Date §

4. End Date §

5. Total Workers §

  1. Address 1 *




  1. Address 2 (suite/floor and number) §

  1. City *

  1. State*

  1. Postal Code *

  1. County *

  1. Address 1 *





  1. Address 2 (suite/floor and number) §

  1. City *

  1. State *

  1. Postal Code *

  1. County *

  1. Address 1 *





  1. Address 2 (suite/floor and number) §

c. City*

d. State *

e. Postal Code *

f. County *

  1. Address 1 *





  1. Address 2 (suite/floor and number) §

c. City *

d. State *

e. Postal Code *

f. County *

  1. Address 1 *





  1. Address 2 (suite/floor and number) §

c. City *

d. State *

e. Postal Code *

f. County *







E. Additional Housing Information

1. Type of Housing *

2. Physical Location *

3. Additional Housing Information §

4. Total Units *

5. Total Occupancy *

Employer-provided

Rental or public accommodations





Employer-provided

Rental or public accommodations





Employer-provided


Rental or public

accommodations





Employer-provided

Rental or public accommodations





Employer-provided

Rental or public accommodations







For Public Burden Statement, see the Instructions for Form ETA-790B.

Form ETA-790B Addendum FOR STATEWORKFORCE AGENCY USE ONLY Page B.3 of B.3

Clearance Order Number: _______________________


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