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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Documenting Family Relationship
Modified
183987
15332
0
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy
Modified
12080153
4009851
162821810
Form and Instruction
WH-380-E
Certification of Health Care Provider for Employee�s Serious Health Condition
Form and Instruction
WH-380-F
Certification of Health Care Provider for Family Member�s Serious Health Condition
Form and Instruction
WH-384
Certification of Qualifying Exigency For Military Family Leave
Form and Instruction
WH-385
Certification for Serious Injury or Illness of Covered Servicemember--for Military Family Leave (Family and Medical Leave Act)
Employee's Notice of Need for FMLA Leave
Modified
13419050
447302
0
Fitness-For-Duty Medical Certifications
Removed
0
0
0
General FMLA Recordkeeping (State, local, tribal)
New
3481350
72528
0
General FMLA Recordkeeping (Federal)
New
3152
66
0
General FMLA Recordkeeping (Private Sector)
Modified
9934548
206970
0
Key Employee Notification (Federal)
New
11
1
0
Key Employee Notification (Private Sector)
Modified
31676
2640
0
Key Employee Notification (State, local, tribal)
New
11100
925
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
New
2351
1
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Modified
7092303
3533
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
New
2485346
1238
0
Notice to Employee of FMLA Designation (Federal)
New
4083
1102
0
Form and Instruction
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (Private Sector)
Modified
12869427
3474802
0
Form and Instruction
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (State, local, tribal)
New
4509815
1217670
0
Form and Instruction
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector)
Modified
16113246
7026841
0
Form and Instruction
WH-381
Notice of Eligibility and Rights & Responsibilities
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal)
New
5646542
2462406
0
Form and Instruction
WH-381
Notice of Eligibility and Rights & Responsibilities
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)
New
5112
2229
0
Form and Instruction
WH-381
Notice of Eligibility and Rights & Responsibilities
Notice to Employee of Pending Cancellation of Health Benefits (Federal)
New
34
3
0
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector)
Modified
105585
8799
0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
New
37000
3083
0
Periodic Employee Status Report
Modified
369704
12323
0
Written Guidance to Employees of FMLA Rights (Handbooks/Manuals)
Removed
0
0
0
Total burden requested under this ICR:
88385575
18969645
162821810
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