Information Collection

Written Notice to Employees of their FMLA Obligations and Employer Expectations

IC 178568 under ICR 200702-1215-001 · OMB 1215-0181.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0181 can be found here:

Documents and Forms

Document Name Document Type
Form WH-381 Written Notice to Employees of their FMLA Obligations and Employer Expectations Form and Instruction
WH-381 Employer Response to Employee Request for Family or Medi WH-381.pdf www.dol.gov/esa/forms/whd/WH-381.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Written Notice to Employees of their FMLA Obligations and Employer Expectations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 301(b) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-381	Employer Response to Employee Request for Family or Medical Leave	WH-381.pdf	http://www.dol.gov/esa/forms/whd/WH-381.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,150,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4,150,000	4,150,000
Annual IC Time Burden (Hours)	345,833	345,833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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