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View Information Collection (IC) List
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1235-0021
ICR Reference No:
201607-1235-003
Status:
Historical Active
Previous ICR Reference No:
201605-1235-001
Agency/Subagency:
DOL/WHD
Agency Tracking No:
Title:
Employment Information Form
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/21/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/30/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2019
12/31/2017
12/31/2017
Responses
37,594
0
37,367
Time Burden (Hours)
12,531
0
12,456
Cost Burden (Dollars)
0
0
0
Abstract:
WHD staff use Form WH-3 as a guide for obtaining information complainants (e.g., current and former employees, unions, and competitor employers) voluntarily provide about alleged violations of agency-administered labor standards. Complainants generally provide the information requested on the form to WHD staff over the telephone or in person. WHD staff use the information to determine whether the agency has jurisdiction to investigate the alleged violation(s). When the WHD schedules a complaint-based investigation, the agency makes the completed Form WH-3 part of the investigation case file. Where the information provided does not support a potential WHD enforcement action, complainants are advised and referred to the appropriate agency for further assistance.
Authorizing Statute(s):
US Code:
29 USC 2004(a)(3)
Name of Law: Employee Polygraph Protection Act
US Code:
29 USC 2616(a)
Name of Law: Family and Medical Leave Act
US Code:
29 USC 1862(a)
Name of Law: Migrant and Seasonal Agricultural Worker Protection Act
US Code:
15 USC 1676
Name of Law: Consumer Credit Protection Act
US Code:
40 USC 3141
Name of Law: Davis Bacon Act
US Code:
41 USC 38
Name of Law: Walsh-Healey Public Contracts Act
US Code:
41 USC 353(a)
Name of Law: McNamara-O'Hara Service Contract Act
US Code:
8 USC 1188(g)
Name of Law: Immigration and Nationality Act
EO: EO 13658 Name/Subject of EO: Establishing a Minimum Wage for Contractors
EO: EO 13706 Name/Subject of EO: Establishing Paid Sick Leave for Contractors
US Code:
29 USC 211(a)
Name of Law: Fair Labor Standards Act
Citations for New Statutory Requirements:
EO: EO 13706 Name/Subject of EO: Establishing Paid Sick Leave for Contractors
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
1235-AA13
Final or interim final rulemaking
81 FR 67598
09/30/2016
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
81 FR 9592
02/25/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 9592
02/25/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Employment Information Form
WH-3, WH-3-Sp
Employment Information Form Spanish
,
Employment Information Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
37,594
37,367
227
0
0
0
Annual Time Burden (Hours)
12,531
12,456
75
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This final rule creates a new entitlement to paid sick leave which is not currently required. As a result, more employees will have the right to file a complaint with the WHD to enforce their entitlement to paid sick leave.
Annual Cost to Federal Government:
$669,607
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Robert Waterman 202 693-0805 waterman.robert@dol.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
09/30/2016
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