Medical Certifications and Recertifications

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

⚠️ Notice: This information collection may be referencing outdated material.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-380 Medical Certifications and Recertifications Form and Instruction
WH-380 Certification of Health Care Provider (Family and Medica WH-380 Med Cert(20080125).doc Form and Instruction

Information Collection (IC) Details

IC Title:	Medical Certifications and Recertifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 825.305 29 CFR 825.306 29 CFR 825.100(d) 29 CFR 825.308 29 CFR 825.307 29 CFR .825.311 (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-380	Certification of Health Care Provider (Family and Medical Leave Act)	WH-380 Med Cert(20080125).doc		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,248,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,035,890	4,126,890	1,909,000
Annual IC Time Burden (Hours)	2,011,963	1,375,630	636,333
Annual IC Cost Burden (Dollars)	102,791,207	91,489,927	11,301,280

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.