Information Collection

Notice to Employee of FMLA Designation (Federal)

IC 187078 under ICR 200810-1215-003 · OMB 1215-0181.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-382 Notice to Employee of FMLA Designation (Federal)	Form and Instruction
WH-382 Designation Notice (Family and Medical Leave Act) WH-382(2008).doc www.dol.gov/esa/whd/forms/wh-382.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(d) 29 CFR 825.305(c) 29 CFR 825.301 29 CFR 825.312 29 CFR 825.127(c)(4)

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-382	Designation Notice (Family and Medical Leave Act)	WH-382(2008).doc	http://www.dol.gov/esa/whd/forms/wh-382.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	4,083	825	0	3,258
Annual IC Time Burden (Hours)	1,102	223	198	681
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.