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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
359252
29938
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
9778099
3020288
184932912
Form and Instruction
WH-384
Certification of Qualifying Exigency for Military Family Leave (Family and Medical Leave Act)
Form and Instruction
WH-385
Certification for Serious Injury or Illness of a Current Servicemember - - for Military Family Leave (Family and Medical Leave Act)
Form and Instruction
WH-380-F
Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act)
Form and Instruction
WH-385-V
Certification for Serious Injury or illness of a Veteran for Military Caregiver Leave (Family and Medical Leave Act)
Form and Instruction
WH-380-E
Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act)
Employee's Notice of Need for FMLA Leave
Modified
16184493
539483
0
General FMLA Recordkeeping (State, local, tribal)
Modified
3628493
75593
0
General FMLA Recordkeeping (Federal)
Modified
3283
68
0
General FMLA Recordkeeping (Private Sector)
Modified
10354444
215718
0
Key Employee Notification (Federal)
Modified
11
1
0
Key Employee Notification (Private Sector)
Modified
29100
2425
0
Key Employee Notification (State, local, tribal)
Modified
8950
746
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
Modified
2138
1
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Modified
6737019
4850
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
Modified
2360844
1492
0
Notice to Employee of FMLA Designation (Federal)
Modified
3802
634
0
Form and Instruction
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (Private Sector)
Modified
11981893
1996982
0
Form and Instruction
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (State, local, tribal)
Modified
4198798
699800
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
11981893
1996982
0
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal)
Modified
4198798
699800
0
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)
Modified
3802
634
0
Form and Instruction
WH-381
Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
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)
Modified
145500
12125
0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Modified
44750
3729
0
Periodic Employee Status Report
Modified
366328
12211
0
Total burden requested under this ICR:
82371724
9313503
184932912
To view an IC, click on IC Title