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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
Unchanged
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
2228773
185726276
Form and Instruction
WH-380-F
Certification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave Act
Form and Instruction
WH-380-E
Certification of Health Care Provider for Employee's Serious Health Condition under the Family and Medical Leave Act
Form and Instruction
WH-385
Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave under the Family and Medical Leave Act
Form and Instruction
WH-385-V
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave under the Family and Medical Leave Act
Form and Instruction
WH-384
Certification for Military Family Leave for Qualifying Exigency under the Family and Medical Leave Act
Employee's Notice of Need for FMLA Leave
Unchanged
15628339
520945
0
General FMLA Recordkeeping (State, local, tribal)
Unchanged
3483759
72578
0
General FMLA Recordkeeping (Federal)
Unchanged
3154
66
0
General FMLA Recordkeeping (Private Sector)
Unchanged
9941425
207113
0
Key Employee Notification (Federal)
Unchanged
14
1
0
Key Employee Notification (Private Sector)
Unchanged
43545
3629
0
Key Employee Notification (State, local, tribal)
Unchanged
15260
1272
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
Unchanged
2048
2
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Unchanged
6455693
4838
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
Unchanged
2262259
1696
0
Notice to Employee of FMLA Designation (Federal)
Modified
3671
612
0
Form and Instruction
WH-382
Designation Notice under the Family and Medical Leave Act
Notice to Employee of FMLA Designation (Private Sector)
Modified
11570155
1928359
0
Form and Instruction
WH-382
Designation Notice under the 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 under the 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 & Rights and Responsibilities under the 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 & Rights and Responsibilities under the 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 & Rights and Responsibilities under the Family and Medical Leave Act
Notice to Employee of Pending Cancellation of Health Benefits (Federal)
Unchanged
46
4
0
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector)
Unchanged
145152
12096
0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Unchanged
50866
4239
0
Periodic Employee Status Report
Unchanged
351364
11712
0
Total burden requested under this ICR:
79357763
8307116
185726276
To view an IC, click on IC Title