View Information Collection Request (ICR) Package
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:
1235-0021
ICR Reference No:
201409-1235-001
Status:
Historical Active
Previous ICR Reference No:
201303-1235-003
Agency/Subagency:
DOL/WHD
Agency Tracking No:
Title:
Employment Information Form
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/11/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/07/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2017
09/30/2016
09/30/2016
Responses
35,350
0
35,000
Time Burden (Hours)
11,783
0
11,667
Cost Burden (Dollars)
0
0
0
Abstract:
WHD staff use Form WH-3 as a guide for obtaining information complainants (e.g., current and former employees, unions, and competitor employers) voluntarily provide about alleged violations of agency-administered labor standards. Complainants generally provide the information requested on the form to WHD staff over the telephone or in person. WHD staff use the information to determine whether the agency has jurisdiction to investigate the alleged violation(s). When the WHD schedules a complaint-based investigation, the agency makes the completed Form WH-3 part of the investigation case file. Where the information provided does not support a potential WHD enforcement action, complainants are advised and referred to the appropriate agency for further assistance.
Authorizing Statute(s):
US Code:
29 USC 1862(a)
Name of Law: Migrant and Seasonal Agricultural Worker Protection Act
US Code:
29 USC 2004(a)(3)
Name of Law: Employee Polygraph Protection Act
US Code:
29 USC 2616(a)
Name of Law: Family and Medical Leave Act
US Code:
15 USC 1676
Name of Law: Consumer Credit Protection Act
US Code:
40 USC 3141
Name of Law: Davis Bacon Act
US Code:
41 USC 38
Name of Law: Walsh-Healey Public Contracts Act
US Code:
41 USC 353(a)
Name of Law: McNamara-O'Hara Service Contract Act
US Code:
8 USC 1188(g)
Name of Law: Immigration and Nationality Act
EO: EO 13658 Name/Subject of EO: Establishing a Minimum Wage for Contractors
US Code:
29 USC 211(a)
Name of Law: Fair Labor Standards Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
1235-AA10
Final or interim final rulemaking
79 FR 60634
10/07/2014
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 34568
06/17/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 34568
10/07/2014
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Employment Information Form
WH-3, WH-3-Sp
Employment Information Form Spanish
,
Employment Information Form
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
35,350
35,000
0
350
0
0
Annual Time Burden (Hours)
11,783
11,667
0
116
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Changing Regulations
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
President Obama issued Executive Order 13658 on February 12, 2014 requiring that the minimum wage be raised to $10.10 per hour for parties who perform work on or in connection with federal government contracts. The EO required the Department of Labor to issue regulations implementing the Order by October 1, 2014. The Department anticipates a slight increase in the number of complaints received as a result of the Executive Order and implementing regulations. As a result, the Department is submitting the ICR to update an increase in responses and burden hours.
Annual Cost to Federal Government:
$632,394
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:
10/07/2014
An official website of the United States government
The .gov means it's official.
The site is secure.
