Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy

29 C.F.R. Part 825, The Family and Medical Leave Act of 1993

OMB: 1215-0181

IC ID: 13897

Information Collection (IC) Details

View Information Collection (IC)

Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy
 
No Modified
 
Required to Obtain or Retain Benefits
 
29 CFR 825.306 29 CFR 825.305 29 CFR 825.100(d) 29 CFR 825.308 29 CFR 825.307 29 CFR 825.213(a)(3) 29 CFR 825.216(b) 29 CFR 825.310 29 CFR 825.312 29 CFR 825.309

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction WH-380-E Certification of Health Care Provider for Employee�s Serious Health Condition WH-380-E(2008).doc http://www.dol.gov/esa/whd/forms/wh-380-E.pdf Yes Yes Fillable Printable
Form and Instruction WH-380-F Certification of Health Care Provider for Family Member�s Serious Health Condition WH-380-F(2008).doc http://www.dol.gov/esa/whd/forms/wh-380-F.pdf Yes Yes Fillable Printable
Form and Instruction WH-384 Certification of Qualifying Exigency For Military Family Leave WH-384(2008).doc http://www.dol.gov/esa/whd/forms/wh-384.pdf Yes Yes Fillable Printable
Form and Instruction WH-385 Certification for Serious Injury or Illness of Covered Servicemember--for Military Family Leave (Family and Medical Leave Act) WH-385(2008).doc http://www.dol.gov/esa/whd/forms/wh-385.pdf Yes Yes Fillable Printable

Workforce Management Labor Rights Management

 

5,454,097 0
   
Individuals or Households
 
   0 %

  Approved 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 12,080,153 1,443,572 0 8,727,581 0 1,909,000
Annual IC Time Burden (Hours) 4,009,851 464,324 0 2,909,194 0 636,333
Annual IC Cost Burden (Dollars) 162,821,810 455,927 3,501,720 147,562,883 0 11,301,280

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