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View Information Collection (IC) List
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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:
201711-1235-001
Status:
Historical Active
Previous ICR Reference No:
201507-1235-001
Agency/Subagency:
DOL/WHD
Agency Tracking No:
Title:
Family and Medical Leave Act of 1993, As Amended
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
08/09/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/20/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2021
36 Months From Approved
08/31/2018
Responses
79,357,763
0
82,371,724
Time Burden (Hours)
8,973,607
0
9,313,503
Cost Burden (Dollars)
193,532,818
0
184,932,912
Abstract:
This ICR implements 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). 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. § 2616.
Authorizing Statute(s):
US Code:
29 USC 2616
Name of Law: Family and Medical Leave Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
82 FR 48850
10/20/2017
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 17566
04/20/2018
Did the Agency receive public comments on this ICR?
No
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-385, WH-384, WH-380-F, WH-385-V, WH-380-E
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 of Health Care Provider for Employee’s Serious Health Condition (Family and Medical Leave Act)
,
Certification of Health Care Provider for Family Member’s Serious Health Condition (Family and Medical Leave Act)
,
Certification for 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 (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (Private Sector)
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (State, local, tribal)
WH-382
Designation Notice (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector)
WH-381
Notice of Eligibility and Rights & 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 & Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)
WH-381
Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act)
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
79,357,763
82,371,724
0
0
-3,013,961
0
Annual Time Burden (Hours)
8,973,607
9,313,503
0
0
-339,896
0
Annual Cost Burden (Dollars)
193,532,818
184,932,912
0
0
8,599,906
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:
There is a slight decrease in responses and burden hours due to a decrease in the estimated number of FMLA eligible workers. The decrease in estimated burden hours produced a slight decrease in total burden cost. There was a modest increase in total operations and maintenance cost which is attributed to a $5.73 increase in the health care provider hourly wage rate applied to the slight reduction in health care provider burden hours. Lastly, Federal cost decreased slightly because printing costs were applied to only half of the total pages calculation to capture printing on the front and back of each page.
Annual Cost to Federal Government:
$690,135
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
robert waterman 202 693-0805 waterman.robert@dol.gov
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:
04/20/2018
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