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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
185681
15473
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
12118019
4022236
163332185
Form and Instruction
WH-380-F
Certification of Health Care Provider for Family Member Serious Health Condition
Form and Instruction
WH-380-E
Certification of Health Care Provider for Employee'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
Employee's Notice of Need for FMLA Leave
Modified
13829680
460990
0
General FMLA Recordkeeping (State, local, tribal)
Unchanged
3481350
72528
0
General FMLA Recordkeeping (Federal)
Unchanged
3152
66
0
General FMLA Recordkeeping (Private Sector)
Unchanged
9934548
206970
0
Key Employee Notification (Federal)
Unchanged
11
1
0
Key Employee Notification (Private Sector)
Unchanged
31676
2640
0
Key Employee Notification (State, local, tribal)
Unchanged
11100
925
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
Unchanged
2351
1
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Modified
7099082
3536
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
Modified
2487721
1239
0
Notice to Employee of FMLA Designation (Federal)
Modified
4092
1104
0
Form and Instruction
WH-382
Designation Notice
Notice to Employee of FMLA Designation (Private Sector)
Modified
12898914
3479716
0
Form and Instruction
WH-382
Designation Notice
Notice to Employee of FMLA Designation (State, local, tribal)
Modified
4520148
1219392
0
Form and Instruction
WH-382
Designation Notice
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector)
Modified
16142733
7031756
0
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal)
Modified
5656874
2464128
0
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)
Modified
5121
2231
0
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities
Notice to Employee of Pending Cancellation of Health Benefits (Federal)
Unchanged
34
3
0
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector)
Unchanged
105585
8799
0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Unchanged
37000
3083
0
Periodic Employee Status Report
Modified
371547
12384
0
Total burden requested under this ICR:
88926419
19009201
163332185
To view an IC, click on IC Title