Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Documenting Family Relationships New 175000 58333 175000
Employee Notice of Need for FMLA Leave Modified 12700000 423333 0
Fitness-For-Duty Medical Certifications Modified 499000 83167 4251480
General Recordkeeping Modified 10500000 218750 0
Key Employee Notifications Modified 62250 5188 0
Medical Certifications and Recertifications Modified 6035890 2011963 102791207 Form and Instruction WH-380 Certification of Health Care Provider (Family and Medical Leave Act)
Notice to Employee of FMLA Leave Designation New 27874998 4645833 0 Form and Instruction WH-382 Notice to Employee of FMLA Leave Designation
Notice to Employee of Pending Cancellation of Health Benefits New 140000 11667 0
Notice to Employees of Change of 12-Month Period for Determining Entitlement Modified 41500 6917 0
Notice to Employees of FMLA Eligibility Modified 12700000 2116667 0 Form and Instruction WH-381 Eligibility Notice (Family and Medical Leave Act)
Periodic Employee Status Report New 350000 11667 0
Written Guidance to Employees of FMLA Rights (Handbooks/Manuals) Removed 0 0 0
Total burden requested under this ICR: 71078638 9593485 107217687  
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