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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:
202005-1235-001
Status:
Historical Active
Previous ICR Reference No:
202003-1235-001
Agency/Subagency:
DOL/WHD
Agency Tracking No:
Title:
Employment Information Form
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/02/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/02/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2022
11/30/2022
11/30/2022
Responses
38,125
0
38,125
Time Burden (Hours)
12,771
0
12,771
Cost Burden (Dollars)
2
0
2
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 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
PL:
Pub.L. 116 - 127 110
Name of Law: Families First Coronavirus Response Act
PL:
Pub.L. 116 - 127 5105
Name of Law: Families First Coronavirus Response Act
US Code:
19 USC 4532
Name of Law: United States-Mexico-Canada Agreement Implementation Act
US Code:
29 USC 2004(a)(3)
Name of Law: Employee Polygraph Protection Act
Citations for New Statutory Requirements:
PL: Pub.L. 116 - 127 5105 Name of Law: Families First Coronavirus Response Act
PL: Pub.L. 116 - 127 110 Name of Law: Families First Coronavirus Response Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
1235-AA20
Final or interim final rulemaking
84 FR 51230
09/27/2019
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
83 FR 19300
05/02/2018
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 51230
09/27/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Employment Information Form
WH-3, WH-3-Sp
Employment Information Form Spanish
,
Employment Information Form
PAID
WH-1527
PAID certificate
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
38,125
38,125
0
0
0
0
Annual Time Burden (Hours)
12,771
12,771
0
0
0
0
Annual Cost Burden (Dollars)
2
2
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:
Annual Cost to Federal Government:
$682,003
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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?
No
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:
07/02/2020
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