Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances

Application of the Employee Polygraph Protection Act

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0005 can be found here:

Documents and Forms

Document Name Document Type
Form WH-1481 Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances Form
WH-1481 Notice to Examinee WH1481.pdf www.dol.gov/esa/forms/whd/WH1481.pdf Form

Information Collection (IC) Details

IC Title:	Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 801.12(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-1481	Notice to Examinee	WH1481.pdf	http://www.dol.gov/esa/forms/whd/WH1481.pdf	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 82,000	Number of Respondents for Small Entity: 77,080

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	164,000	-164,000	328,000
Annual IC Time Burden (Hours)	2,733	-66,006	68,739
Annual IC Cost Burden (Dollars)	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.