View Information Collection (IC)

View Information Collection (IC)

IC Title:	Notice to Employees of Coverage Options Under FLSA Section 18B (State and Local Gov't)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Notice			FLSA Model Notice with Plans.pdf		Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90,100	Number of Respondents for Small Entity: 72,800

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 52 %

	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	3,920,312	0	0	3,920,312	0	0
Annual IC Time Burden (Hours)	15,746	0	0	15,746	0	0
Annual IC Cost Burden (Dollars)	633,013	0	0	633,013	0	0

Documents for IC

Title	Document	Date Uploaded
Technical Release 2013-02	DOL TR 2013-02.pdf	01/25/2017

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