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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
172237
14353
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
9901840
2361231
195834007
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
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-380-F
Certification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave Act
Employee's Notice of Need for FMLA Leave
Modified
16300273
543342
0
General FMLA Recordkeeping (State, local, tribal)
Modified
3658082
76210
0
General FMLA Recordkeeping (Federal)
Modified
3312
69
0
General FMLA Recordkeeping (Private Sector)
Unchanged
10438879
217477
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
9
2
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Modified
29031
4839
0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
Unchanged
10173
1696
0
Notice to Employee of FMLA Designation (Federal)
Modified
3829
638
0
Form and Instruction
WH-382
Designation Notice under the Family and Medical Leave Act
Notice to Employee of FMLA Designation (Private Sector)
Modified
12067609
2011268
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
4228835
704806
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)
Unchanged
12067609
2011268
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
4228835
704806
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
3829
638
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:
73720629
8685596
195834007
To view an IC, click on IC Title