Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Documenting Family Relationship Modified 180577 15048 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 10381263 2475556 251749336 Form and Instruction WH-385
Form and Instruction WH-385-V
Form and Instruction WH-384
Form and Instruction WH-380-E
Form and Instruction WH-380-F
Employee's Notice of Need for FMLA Leave Modified 16982974 566099 0
General FMLA Recordkeeping (State, local, tribal) Modified 3835197 79900 0
General FMLA Recordkeeping (Federal) Modified 3472 72 0
General FMLA Recordkeeping (Private Sector) Modified 10944305 228007 0
Key Employee Notification (Federal) Modified 2 0 0
Key Employee Notification (Private Sector) Modified 39287 3274 0
Key Employee Notification (State, local, tribal) Modified 13719 1143 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal) Modified 1 0 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector) Modified 26191 4365 0
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal) Modified 9146 1524 0
Notice to Employee of FMLA Designation (Federal) Modified 3989 665 0 Form and Instruction WH-382
Notice to Employee of FMLA Designation (Private Sector) Modified 12573035 2095506 0 Form and Instruction WH-382
Notice to Employee of FMLA Designation (State, local, tribal) Modified 4405950 734325 0 Form and Instruction WH-382
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Modified 12573035 2095506 0 Form and Instruction WH-381
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Modified 4405950 734325 0 Form and Instruction WH-381
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Modified 3989 665 0 Form and Instruction WH-381
Notice to Employee of Pending Cancellation of Health Benefits (Federal) Modified 1 0 0
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector) Modified 130956 10913 0
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal) Modified 45731 3811 0
Periodic Employee Status Report Modified 368376 12279 0
Total burden requested under this ICR: 76927146 9062983 251749336  
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