Notice to Employee of FMLA Designation (Federal)

29 C.F.R. Part 825, The Family and Medical Leave Act of 1993

⚠️ Notice: This information collection may be referencing outdated material.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 (Federal) Form and Instruction
WH-382 Designation Notice WH-382 (Designation)[1].pdf www.dol.gov/whd/forms/WH-382.pdf Form and Instruction

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-382	Designation Notice	WH-382 (Designation)[1].pdf	http://www.dol.gov/whd/forms/WH-382.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: 67	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	4,092	9	4,083
Annual IC Time Burden (Hours)	1,104	2	1,102
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.