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Notice to Employee of Pending Cancellation of Health Benefits
29 CFR Part 825, The Family and Medical Leave Act of 1993
OMB: 1215-0181
IC ID: 182234
OMB.report
DOL/ESA
OMB 1215-0181
ICR 200709-1215-004
IC 182234
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0181 can be found here:
2008-11-17 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Notice to Employee of Pending Cancellation of Health Benefits
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 825.212(a)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
140,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
140,000
0
0
140,000
0
0
Annual IC Time Burden (Hours)
11,667
0
0
11,667
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.