View Information Collection (IC)

View Information Collection (IC)

IC Title:	Medical Certifications and Recertifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 825.305 29 CFR 825.307 29 CFR 825.308 29 CFR 825.306

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-380	Certication of Health Care Provider (FMLA)	wh380.pdf	http://www.dol.gov/esa/regs/compliance/whd/fmla/wh380.pdf	Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,909,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,909,000	0	0	-13,148,750	0	15,057,750
Annual IC Time Burden (Hours)	636,333	0	0	-733,770	0	1,370,103
Annual IC Cost Burden (Dollars)	11,301,280	0	0	11,301,280	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.