29 CFR Part 825, The Family and Medical Leave Act of 1993

Forms and Documents

Document	Type	Status	Availability
Form WH-381 Written Notice to Employees of their FMLA Obligations and Employer Expectations	Form and Instruction	New	Available
Form WH-380 Medical Certifications and Recertifications	Form and Instruction	Modified	Available
1215-0181ss(20070608).doc	Supporting Statement A	Uploaded 2007-06-08	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
178656	Recordkeeping		New
178655	Key Employee Notifications		New
178654	Fitness-For-Duty Medical Certifications		New
178653	Notice to Employees of Change of 12-Month Period for Determining FMLA Entitlement		New
178608	Written Guidance to Employees of FMLA Rights (Handbooks/Manuals)		New
178607	Employee Notice of Need for FMLA Leave		New
178568	Written Notice to Employees of their FMLA Obligations and Employer Expectations	Form and Instruction	New
13897	Medical Certifications and Recertifications	Form and Instruction	Modified

ICR Details

OMB Control No: 1215-0181	ICR Reference No: 200702-1215-001
Status: Historical Active	Previous ICR Reference No: 200406-1215-001
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: 29 CFR Part 825, The Family and Medical Leave Act of 1993
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: 09/20/2007
	Date Received in OIRA: 06/14/2007
Terms of Clearance: This collection is approved in accordance with the following terms of clearance. We understand that the Department of Labor is considering public comments submitted in response to the December 2006 request for information on FMLA and that the Department will resubmit this collection for approval if any changes are made as a result of the input received from the public.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	36 Months From Approved	09/30/2007
Responses	15,058,850	0	15,057,750
Time Burden (Hours)	1,370,288	0	1,370,103
Cost Burden (Dollars)	11,915,480	0	0

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Abstract: The Family and Medical Leave Act of 1993 (FMLA) requires private sector employers of 50 or more employees, and public agencies to provide up to 12 weeks of unpaid, job-protected leave to "eligible" employees for certain family and medical reasons. Records are required so that the Department of Labor can determine employer compliance with FMLA.

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Authorizing Statute(s): US Code: 29 USC 2601, et seq Name of Law: Family and Medical Leave Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 13530	03/22/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32866	06/14/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Employee Notice of Need for FMLA Leave
Written Guidance to Employees of FMLA Rights (Handbooks/Manuals)
Fitness-For-Duty Medical Certifications
Notice to Employees of Change of 12-Month Period for Determining FMLA Entitlement
Key Employee Notifications
Recordkeeping
Medical Certifications and Recertifications	WH-380	Certication of Health Care Provider (FMLA)
Written Notice to Employees of their FMLA Obligations and Employer Expectations	WH-381	Employer Response to Employee Request for Family or Medical Leave

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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	15,058,850	15,057,750	0	0	1,100	0
Annual Time Burden (Hours)	1,370,288	1,370,103	0	0	185	0
Annual Cost Burden (Dollars)	11,915,480	0	0	0	11,915,480	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: Burden estimates in this paperwork submission have increased due to the use of current census data to determine the number of covered employees and current BLS data to determine the cost of the burden hours. Moreover, the number of respondents increased to 6,657,500 (6.658 million rounded) from 6,656,500 (6.657 million rounded)—or by 1,000 respondents, and the total annual responses increased to 15,058,850 (15.059 million rounded) from 15,057,750 (15.058 million rounded)–or by 1,100 total responses. Burden hours increased slightly from 1,370,103 to 1,370,288 hours, or an adjustment of 185 hours. Prior paperwork packages for this information collection did not separately state costs associated with obtaining medical certifications. DOL efforts to quantify that figure result in an increase of = $11,915,480 in operational costs.

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Annual Cost to Federal Government: $2,654,755

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 06/14/2007

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