Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1235-0003
ICR Reference No:
201408-1235-001
Status:
Historical Active
Previous ICR Reference No:
201303-1235-001
Agency/Subagency:
DOL/WHD
Agency Tracking No:
Title:
29 C.F.R. Part 825, The Family and Medical Leave Act of 1993
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/10/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/08/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2015
02/28/2015
02/28/2015
Responses
89,305,469
0
89,305,469
Time Burden (Hours)
19,027,093
0
19,027,093
Cost Burden (Dollars)
163,467,915
0
163,467,915
Abstract:
The DOL created the subject information collections (i.e., notifications) to implement statutory notice and certification provisions and to assist employees and employers in meeting their FMLA third-party notification obligations as required by the Family and Medical Leave Act of 1993 (FMLA) and by the amendments to FMLA contained in National Defense Authorization Act for FY 2010 (NDAA), Pub. L. No. 111-84, and Airline Flight Crew Technical Corrections Act, Pub. L. No. 111-119. The subject recordkeeping requirements are necessary in order for the DOL to carry out its statutory obligation under FMLA section 106 to investigate and ensure employer compliance. 29 U.S.C. ยง 2616.
Authorizing Statute(s):
US Code:
29 USC 2601, et seq.
Name of Law: Family and Medical Leave Act
Citations for New Statutory Requirements:
PL: Pub.L. 101 - 181 585(a)(s)-(3)(D) Name of Law: National Defense Authorization Act for Fiscal Year 2008
PL: Pub.L. 111 - 19 2 Name of Law: Airline Flight Crew Technical Corrections Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
1235-AA03
Final or interim final rulemaking
78 FR 8834
02/06/2013
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
77 FR 8960
02/15/2012
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
22
IC Title
Form No.
Form Name
Documenting Family Relationship
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
WH-380-E, WH-384, WH-385, WH-385-V, WH-380-F
Certification of Health Care Provider for Family Member Serious Health Condition
,
Certification of Health Care Provider for Employee's Serious Health Condition
,
Certification of Qualifying Exigency for Military Family Leave (Family and Medical Leave Act)
,
Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave (Family and Medical Leave Act)
,
Certification for a Serious Injury or Illness of a Veteran for Military Caregiver Leave (Family and Medical Leave Act)
Employee's Notice of Need for FMLA Leave
General FMLA Recordkeeping (State, local, tribal)
General FMLA Recordkeeping (Federal)
General FMLA Recordkeeping (Private Sector)
Key Employee Notification (Federal)
Key Employee Notification (Private Sector)
Key Employee Notification (State, local, tribal)
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
Notice to Employee of FMLA Designation (Federal)
WH-382
Designation Notice
Notice to Employee of FMLA Designation (Private Sector)
WH-382
Designation Notice
Notice to Employee of FMLA Designation (State, local, tribal)
WH-382
Designation Notice
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector)
WH-381, WH-381
Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
,
Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal)
WH-381
Notice of Eligibility and Rights and Responsibilities
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)
WH-381
Notice of Eligibility and Rights and Responsibilities
Notice to Employee of Pending Cancellation of Health Benefits (Federal)
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector)
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Periodic Employee Status Report
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
89,305,469
89,305,469
0
0
0
0
Annual Time Burden (Hours)
19,027,093
19,027,093
0
0
0
0
Annual Cost Burden (Dollars)
163,467,915
163,467,915
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Compared to the last OMB clearance of the FMLA information collections on February 9, 2012, this request reflects an overall burden increase of 17,892 hours that results from proposed regulatory changes. In addition, this request reflects an increase of 379,050 responses, which also stem from proposed regulatory changes, and a difference of $135,730 in maintenance and operations costs. The changed paperwork burden estimates stem from the expansion of FMLA-leave to employees to care for covered veterans with serious injuries or illnesses; and increased wages rates for persons completing the information collections and other higher costs, as discussed in Item 13 of the supporting statement.
Annual Cost to Federal Government:
$651,550
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Mary Ziegler 202 693-0517
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
09/08/2014
An official website of the United States government
The .gov means it's official.
The site is secure.
