Information Collection

Notice to Employee of FMLA Designation (Private Sector)

IC 182081 under ICR 201003-1235-003 · OMB 1235-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0003 can be found here:

Documents and Forms

Document Name Document Type
Form WH-382 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction
WH-382 Designation Notice (Family and Medical Leave Act) WH-382(2008).doc www.dol.gov/esa/whd/forms/wh-381.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice to Employee of FMLA Designation (Private Sector)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 825.127(c)(4) 29 CFR 825.300(d) 29 CFR 825.301 29 CFR 825.305(c) 29 CFR 825.312

Information Collection 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-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: 211,170	Number of Respondents for Small Entity: 194,123

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	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	12,869,427	2,599,386	0	10,270,041
Annual IC Time Burden (Hours)	3,474,802	701,846	628,056	2,144,900
Annual IC Cost Burden (Dollars)	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.