View Information Collection (IC)

View Information Collection (IC)

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
No Modified
Required to Obtain or Retain Benefits
29 CFR 825.306 29 CFR 825.305 29 CFR 825.100(d) 29 CFR 825.308 29 CFR 825.307 29 CFR 825.213(a)(3) 29 CFR 825.216(b) 29 CFR 825.310 29 CFR 825.312 29 CFR 825.309

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction WH-380-E Certification of Health Care Provider for Employee�s Serious Health Condition WH-380-E(2008).doc Yes Yes Fillable Printable
Form and Instruction WH-380-F Certification of Health Care Provider for Family Member�s Serious Health Condition WH-380-F(2008).doc Yes Yes Fillable Printable
Form and Instruction WH-384 Certification of Qualifying Exigency For Military Family Leave WH-384(2008).doc Yes Yes Fillable Printable
Form and Instruction WH-385 Certification for Serious Injury or Illness of Covered Servicemember--for Military Family Leave (Family and Medical Leave Act) WH-385(2008).doc Yes Yes Fillable Printable

Workforce Management Labor Rights Management


5,454,097 0
Individuals or Households
   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 12,080,153 1,443,572 0 8,727,581 0 1,909,000
Annual IC Time Burden (Hours) 4,009,851 464,324 0 2,909,194 0 636,333
Annual IC Cost Burden (Dollars) 162,821,810 455,927 3,501,720 147,562,883 0 11,301,280

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