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

ICR 201207-1235-001

OMB: 1235-0003

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
187163
Unchanged
187079
Unchanged
187078
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187073
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186957
Unchanged
186955
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186913
Modified
186900
Unchanged
186899
Modified
186898
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186891
Unchanged
186890
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182234
Unchanged
182233
Modified
182083
Modified
182081
Modified
178656
Unchanged
178655
Unchanged
178653
Unchanged
178607
Modified
178568
Modified
13897
Modified
ICR Details
1235-0003 201207-1235-001
Historical Inactive 201112-1235-003
DOL/WHD
29 C.F.R. Part 825, The Family and Medical Leave Act of 1993
Revision of a currently approved collection   No
Regular
Preapproved 02/05/2013
Retrieve Notice of Action (NOA) 01/24/2013
  Inventory as of this Action Requested Previously Approved
02/28/2015 02/28/2015 02/28/2015
89,305,469 0 88,926,419
19,027,093 0 19,009,201
163,467,915 0 163,332,185

The DOL created the subject information collections (i.e., notifications) to implement statutory notice and certification provisions and to assist employees and employers in meeting their FMLA third-party notification obligations as required by the Family and Medical Leave Act of 1993 (FMLA) and by the amendments to FMLA contained in National Defense Authorization Act for FY 2010 (NDAA), Pub. L. No. 111-84, and Airline Flight Crew Technical Corrections Act, Pub. L. No. 111-119. The subject recordkeeping requirements are necessary in order for the DOL to carry out its statutory obligation under FMLA section 106 to investigate and ensure employer compliance. 29 U.S.C. § 2616.

US Code: 29 USC 2601, et seq. Name of Law: Family and Medical Leave Act
  
PL: Pub.L. 101 - 181 585(a)(s)-(3)(D) Name of Law: National Defense Authorization Act for Fiscal Year 2008
PL: Pub.L. 111 - 19 2 Name of Law: Airline Flight Crew Technical Corrections Act

1235-AA03 Final or interim final rulemaking

  77 FR 8960 02/15/2012
Yes

22
IC Title Form No. Form Name
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) WH-381
Notice to Employee of FMLA Designation (State, local, tribal) WH-382
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Notice to Employee of FMLA Designation (Federal) WH-382
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) WH-381
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
Notice to Employee of Pending Cancellation of Health Benefits (Federal)
Key Employee Notification (State, local, tribal)
Key Employee Notification (Federal)
Periodic Employee Status Report
Notice to Employee of FMLA Designation (Private Sector) WH-382
Documenting Family Relationship
Employee's Notice of Need for FMLA Leave
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Key Employee Notification (Private Sector)
General FMLA Recordkeeping (Private Sector)
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy WH-384, WH-385, WH-385-V, WH-380-F, WH-380-E
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) WH-381
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector)
General FMLA Recordkeeping (State, local, tribal)
General FMLA Recordkeeping (Federal)
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 89,305,469 88,926,419 379,050 0 0 0
Annual Time Burden (Hours) 19,027,093 19,009,201 17,892 0 0 0
Annual Cost Burden (Dollars) 163,467,915 163,332,185 135,730 0 0 0
No
No
Compared to the last OMB clearance of the FMLA information collections on February 9, 2012, this request reflects an overall burden increase of 17,892 hours that results from proposed regulatory changes. In addition, this request reflects an increase of 379,050 responses, which also stem from proposed regulatory changes, and a difference of $135,730 in maintenance and operations costs. The changed paperwork burden estimates stem from the expansion of FMLA-leave to employees to care for covered veterans with serious injuries or illnesses; and increased wages rates for persons completing the information collections and other higher costs, as discussed in Item 13 of the supporting statement.

$651,550
No
No
No
No
No
Uncollected
Mary Ziegler 202 693-0517

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/24/2013


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