Information Collection

Notice to Employees of FMLA Eligibility

IC 178568 under ICR 200709-1215-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form WH-381 Notice to Employees of FMLA Eligibility	Form and Instruction
WH-381 Eligibility Notice (Family and Medical Leave Act) WH-381 Eligibility(20080125).doc	Form and Instruction

IC Title:

Notice to Employees of FMLA Eligibility

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 219 29 CFR 300(b) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-381	Eligibility Notice (Family and Medical Leave Act)	WH-381 Eligibility(20080125).doc		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 415,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,700,000	0	8,550,000	4,150,000
Annual IC Time Burden (Hours)	2,116,667	1,058,334	712,500	345,833
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
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.