DOL OFLC, Appendix A.1

OMB Approval: 1205-0466 Expiration Date: 02/29/2012 Application for Temporary Employment Certification ETA Form 9142 – APPENDIX A.1 U.S. Department of Labor For Use in Filing Applications Under the H-2A Agricultural Program ONLY A. Rate of Pay Information for Multiple Crop or Agricultural Activities Important Note: The rate of pay for each crop or agricultural activity MUST begin in the spaces below. If necessary, add attachment to continue and complete the rate of pay for all crop activities covered by the application. Agricultural Crop Activity Hourly Wage Piece Rate Wage Piece Rate Unit(s) Special Pay (bonus, etc.) $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ $ ____ . ___ OMB Paperwork Reduction Act Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondent’s reply to these reporting requirements is mandatory to obtain the benefits of temporary employment certification (Immigration and Nationality Act, Section 101 (a)(15)(H)(ii .

Public reporting burden for this collection of information is estimated to average 2 hours 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to the Office of Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW * Washington, DC * 20210. Do NOT send the completed application to this address. ETA Form 9142 – Appendix A.1 FOR DEPARTMENT OF LABOR USE ONLY Page A.1 of A.1 Case Number:___________________ Case Status: __________________ Validity Period: ______________ to _______________