Information Collection

Family and Medical Leave Act Survey- Employer Survey

IC 198682 under ICR 201201-1235-002 · OMB 1235-0026.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0026 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FMLA OMB Attachment C Employer Survey_Final (3).doc	Other-Telephone Survey
FMLA OMB Attachment A advance letter-employers_Final.doc FMLA OMB Attachment A advance Letter employer final	IC Document
FMLA OMB Attachment A advanceletter-employers project info sheet_Final.doc FMLA OMB Attachment A advance Letter employer project info sheet	IC Document
FMLA OMB Attachment B Privacy Statement_Final.doc FMLA OMB Attachment B Privacy Statement Final	IC Document

IC Title:

Family and Medical Leave Act Survey- Employer Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 825

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
Other-Telephone Survey			FMLA OMB Attachment C Employer Survey_Final (3).doc		No		Paper Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,572

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, 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	2,572	2,572
Annual IC Time Burden (Hours)	2,164	2,164
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FMLA OMB Attachment A advance Letter employer final	FMLA OMB Attachment A advance letter-employers_Final.doc	01/09/2012
FMLA OMB Attachment A advance Letter employer project info sheet	FMLA OMB Attachment A advanceletter-employers project info sheet_Final.doc	01/09/2012
FMLA OMB Attachment B Privacy Statement Final	FMLA OMB Attachment B Privacy Statement_Final.doc	01/09/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.