Eta Form 9035 & 9035e Draft - Labor Condition Application For Nonimmigrant Workers (Page 6 of 6) in pdf

OMB Approval: 1205-0310

Expiration Date:

XX/XX/XXXX

Labor Condition Application for Nonimmigrant Workers

ETA Form 9035 & 9035E

U.S. Department of Labor

K. LCA Preparer

Important Note: Complete this section if the preparer of this LCA is a person other than the one identified in either Section D (employer point

of contact) or E (attorney or agent) of this application.

1. Last (family) name

2. First (given) name

3. Middle initial

4. Firm/Business name

5. E-Mail address

L. U.S. Government Agency Use (ONLY)

By virtue of the signature below, the Department of Labor hereby acknowledges the following:

This certification is valid from _______________________ to _______________________.

______________________________________________

______________________________

Department of Labor, Office of Foreign Labor Certification

Certification Date (date signed)

______________________________________________

______________________________

Case number

Case Status

The Department of Labor is not the guarantor of the accuracy, truthfulness, or adequacy of a certified LCA.

M. Signature Notification and Complaints

The signatures and dates signed on this form will not be filled out when electronically submitting to the Department of Labor for processing,

but MUST be complete when submitting non-electronically. If the application is submitted electronically, any resulting certification MUST be

signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

Complaints alleging misrepresentation of material facts in the LCA and/or failure to comply with the terms of the LCA may be filed using the

WH-4 Form with any office of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor. A listing of the

Wage and Hour Division offices can be obtained at Complaints alleging failure to offer employment to an equally or better

qualified U.S. worker, or an employer’s misrepresentation regarding such offer(s) of employment, may be filed with the U.S. Department of

Justice, Office of the Special Counsel for Immigration-Related Unfair Employment Practices, 950 Pennsylvania Avenue, NW, Washington, DC,

20530, and additional information can be obtained at Please note that complaints should be filed with the Office of Special

Counsel at the Department of Justice only if the violation is by an employer who is H-1B dependent or a willful violator as defined in 20 CFR

655.710(b) and 655.734(a)(1)(ii).

N. OMB Paperwork Reduction Act (1205-0310)

These reporting instructions have been approved under the Paperwork Reduction Act of 1995. Persons are not required to respond to this

collection of information unless it displays a currently valid OMB control number. Obligations to reply are mandatory (Immigration and

Nationality Act, Section 212(n) and (t) and 214(c). Public reporting burden for this collection of information, which is to assist with program

management and to meet Congressional and statutory requirements is estimated to average 75 minutes per response, including the time to

review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of

information.

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, Employment and Training Administration, Office of Foreign Labor Certification, 200 Constitution

Ave., NW, Box PPII 12-200, Washington, DC, 20210. (Paperwork Reduction Project OMB 1205-0310.) Do NOT send the completed

application to this address.

Form ETA 9035/9035E

FOR DEPARTMENT OF LABOR USE ONLY

Page 6 of 6

Case Number:_______________________ Case Status: __________________ Period of Employment: ______________ to _______________

Eta Form 9035 & 9035e Draft - Labor Condition Application For Nonimmigrant Workers Page 6

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