Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Documenting Family Relationship Unchanged 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 Unchanged 16184493 539483 0
General FMLA Recordkeeping (State, local, tribal) Unchanged 3628493 75593 0
General FMLA Recordkeeping (Federal) Unchanged 3283 68 0
General FMLA Recordkeeping (Private Sector) Unchanged 10354444 215718 0
Key Employee Notification (Federal) Unchanged 11 1 0
Key Employee Notification (Private Sector) Unchanged 29100 2425 0
Key Employee Notification (State, local, tribal) Unchanged 8950 746 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal) Unchanged 2138 1 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector) Unchanged 6737019 4850 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal) Unchanged 2360844 1492 0
Notice to Employee of FMLA Designation (Federal) Unchanged 3802 634 0 Form and Instruction WH-382 Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (Private Sector) Unchanged 11981893 1996982 0 Form and Instruction WH-382 Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (State, local, tribal) Unchanged 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) Unchanged 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) Unchanged 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) Unchanged 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) Unchanged 145500 12125 0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal) Unchanged 44750 3729 0
Periodic Employee Status Report Unchanged 366328 12211 0
Total burden requested under this ICR: 82371724 9313503 184932912  
To view an IC, click on IC Title