Information Collection

Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)

IC 186955 under ICR 200810-1215-003 · OMB 1215-0181.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-381 Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)	Form and Instruction
WH-381 Notice of Eligibility and Rights & Responsibilities WH-381(2008).doc www.dol.gov/esa/whd/forms/wh-381.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 825.300(b), (c)

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	Notice of Eligibility and Rights & Responsibilities	WH-381(2008).doc	http://www.dol.gov/esa/whd/forms/wh-381.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 67

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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
Annual Number of Responses for this IC	5,112	1,033	188	3,891
Annual IC Time Burden (Hours)	2,229	450	1,439	340
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.