Form Eta 232a - Wage Survey Interview Record printable pdf download

Form Eta 232a - Wage Survey Interview Record

Wage Survey Interview Record

US Department of Labor

Employment and Training Administration

1. Area

2. Crop

3. Date

OMB Approval No. 1205-0017

Time

Expires: 7/31/2013

5. Active Acreage of

6. Percent Completed

7. Method of Contact

Total Production

8. Name of Employer

9. Address(No., St., City, State, ZIP Code)

10. No. of Foreign Workers

11. Interviewer

12. Local Office Address

Part I. Number of Domestic Hired Workers in Crop Activity by Rate

Crop Activity

Rate(Amount Per Unit)

Total

Instate

Interstate

(

(Local and Interstate)

Including Contract

Puerto Rican)

Part II. Productivity and Average Hourly Earnings of Piece Rate Workers

Rate Amount

Number

Total Units

Average

Worker Interviews

For Unit

Hurly

Workers

Hours

Number

Average

Worked

Hourly

Rate

Unit

Part III. Variable Affecting Rates, Crop Conditions, or Other Explanatory and Pertinent Information

Name of Person Interviewed

Position

Date

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents obligations to reply to these

reporting requirements are voluntary (20 CFR 653.000 and 20 CFR 655). Public reporting burden for this collection of information is estimated to average 15 mins. per

response, including the time for reviewing instruction, searching existing data sources , gathering and maintaining the data needed, and completing and reviewing the

collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S.

Department of Labor, Office of National Programs, Room C-4312, 200 Constitution Avenue, N.W., Washington, D.C. 20210 (Paperwork Reduction 1205-0017).

ETA 232A September 1990