Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Documenting Family Relationship Modified 344474 28706 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 9373687 2895264 193532818 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-E Certification of Health Care Provider for Employee’s Serious Health Condition (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)
Employee's Notice of Need for FMLA Leave Modified 15628339 520945 0
General FMLA Recordkeeping (State, local, tribal) Modified 3483759 72578 0
General FMLA Recordkeeping (Federal) Modified 3154 66 0
General FMLA Recordkeeping (Private Sector) Modified 9941425 207113 0
Key Employee Notification (Federal) Modified 14 1 0
Key Employee Notification (Private Sector) Modified 43545 3629 0
Key Employee Notification (State, local, tribal) Modified 15260 1272 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal) Modified 2048 2 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector) Modified 6455693 4838 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal) Modified 2262259 1696 0
Notice to Employee of FMLA Designation (Federal) Modified 3671 612 0 Form and Instruction WH-382 Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (Private Sector) Modified 11570155 1928359 0 Form and Instruction WH-382 Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (State, local, tribal) Modified 4054513 675752 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 11570155 1928359 0 Form and Instruction WH-381 Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Modified 4054513 675752 0 Form and Instruction WH-381 Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Modified 3671 612 0 Form and Instruction WH-381 Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act)
Notice to Employee of Pending Cancellation of Health Benefits (Federal) Modified 46 4 0
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector) Modified 145152 12096 0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal) Modified 50866 4239 0
Periodic Employee Status Report Modified 351364 11712 0
Total burden requested under this ICR: 79357763 8973607 193532818  
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