Information Collection

Notice to Employee of FMLA Designation (Private Sector)

IC 182081 under ICR 201202-1235-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form WH-382 Notice to Employee of FMLA Designation (Private Sector)	Form and Instruction
WH-382 Designation Notice WH-382 (Designation)[1].pdf www.dol.gov/whd/forms/WH-382.pdf	Form and Instruction

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

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 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: 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 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12,910,389	11,475	12,898,914
Annual IC Time Burden (Hours)	3,481,629	1,913	3,479,716
Annual IC Cost Burden (Dollars)	0	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.