Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ER recordkeeping (private) EPSLA New 950000 19792 0
Concurrent Leave Notice (Federal) New 20 1 0
Concurrent Leave Notice (State/local/tribal) New 230 7 0
Concurrent Leave Records (Federal) New 20 1 0
Concurrent Leave Records (State/local/tribal) New 230 4 0
Concurrent Leave Records (private) New 4750 99 0
Concurrent leave notice (private) New 4750 159 0
EFMLEA Employee Notice (Federal) New 300 10 0
EFMLEA Employee Notice (State/local/tribal) New 134454 4482 0
EFMLEA Employee Notice (private) New 2560326 85344 0
EFMLEA Employer Record (State/local/tribal) New 110502 2302 0
EFMLEA Employer Record (private) New 2187017 45563 0
EFMLEA Employer Reocrd (Federal) New 4604 96 0
ER notice to EE failure to meet notice req (State/local/tribal) New 4800 160 0
ER notice to EE of failure to meet notice req (federal) New 200 7 0
ER notice to EE of failure to meet notice req (private) New 95000 3167 0
ER recordkeeping (Federal) EPSlA New 2000 42 0
ER recordkeeping (public State/local/tribal) EPSLA New 48000 1000 0
Health Benefits Notice (private) New 170337 14195 0
Health Care Provider Certification (Federal) New 100 33 0
Health Care Provider Certification (State/local/tribal) New 2400 800 0
Health Care Provider Certification (private) New 47500 15834 0
Paid Sick Leave Notice of Need for Leave (Federal) New 2000 66 0
Paid Sick Leave Notice of Need for Leave (private) New 950000 31667 0
Paid Sick Leave Notice of Need for Leave (state, local, tribal) New 48000 1600 0
Small Employer Exemption (State/local/tribal) New 28776 28776 0
Small Employer Exemption Record (Private) New 546755 546755 0
Total burden requested under this ICR: 7903071 801962 0  
To view an IC, click on IC Title