Information Collection

Employee's Notice of Need for FMLA Leave

IC 178607 under ICR 200810-1215-003 · OMB 1215-0181.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Employee's Notice of Need for FMLA Leave

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 825.302 29 CFR 825.301(b) 29 CFR 825.100(d) 29 CFR 825.303

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

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,249,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	13,419,050	2,710,400	0	6,558,650	4,150,000
Annual IC Time Burden (Hours)	447,302	90,347	178,477	109,311	69,167
Annual IC Cost Burden (Dollars)	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.