Information Collection

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

IC 13874 under ICR 201102-1235-001 · OMB 1235-0005.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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-Employee Polygraph Protection Act WH-1481-2011.pdf www.dol.gov/whd/forms/wh1481.pdf	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-1481	Notice to Examinee-Employee Polygraph Protection Act	WH-1481-2011.pdf	http://www.dol.gov/whd/forms/wh1481.pdf	Yes	No	Fillable Printable

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	164,000	164,000
Annual IC Time Burden (Hours)	2,733	2,733
Annual IC Cost Burden (Dollars)	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.