Employment Information

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form WH-3-Sp Employment Information Form	Form and Instruction	Modified	Repair queued
Executive Order 13658.docx	Supplementary Document	Uploaded 2014-06-03	Available
ss1235-0021 (20140617).doc	Supporting Statement A	Uploaded 2014-06-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13616	Employment Information Form	Form and Instruction	Modified

ICR Details

OMB Control No: 1235-0021	ICR Reference No: 201405-1235-001
Status: Historical Inactive	Previous ICR Reference No: 201303-1235-003
Agency/Subagency: DOL/WHD	Agency Tracking No:
Title: Employment Information
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 08/15/2014
	Date Received in OIRA: 06/17/2014
Terms of Clearance: The revised information collection provisions of this collection are not approved at this time. Approval of the existing requirements continues. DOL will resubmit the request for approval of the revisions at the time of the final rule and will respond to comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	09/30/2016	09/30/2016
Responses	35,000	0	35,000
Time Burden (Hours)	11,667	0	11,667
Cost Burden (Dollars)	0	0	0

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Abstract: WHD staff use Form WH-3 as a guide for obtaining information complainants (e.g., current and former employees, unions, and competitor employers) voluntarily provide about alleged violations of agency-administered labor standards. Complainants generally provide the information requested on the form to WHD staff over the telephone or in person. WHD staff use the information to determine whether the agency has jurisdiction to investigate the alleged violation(s). When the WHD schedules a complaint-based investigation, the agency makes the completed Form WH-3 part of the investigation case file. Where the information provided does not support a potential WHD enforcement action, complainants are advised and referred to the appropriate agency for further assistance.

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Authorizing Statute(s): US Code: 29 USC 211(a) Name of Law: Fair Labor Standards Act
   US Code: 29 USC 1862(a) Name of Law: Migrant and Seasonal Agricultural Worker Protection Act
   US Code: 29 USC 2004(a)(3) Name of Law: Employee Polygraph Protection Act
   US Code: 29 USC 2616(a) Name of Law: Family and Medical Leave Act
   US Code: 15 USC 1676 Name of Law: Consumer Credit Protection Act
   US Code: 40 USC 3141 Name of Law: Davis Bacon Act
   US Code: 41 USC 38 Name of Law: Walsh-Healey Public Contracts Act
   US Code: 41 USC 353(a) Name of Law: McNamara-O'Hara Service Contract Act
   US Code: 8 USC 1188(g) Name of Law: Immigration and Nationality Act
   EO: EO 13658 Name/Subject of EO: Establishing a Minimum Wage for Contractors
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1235-AA10	Proposed rulemaking	79 FR 34568	06/17/2014

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 22912	04/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 54277	09/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Employment Information Form	WH-3, WH-3-Sp	Employment Information Form Spanish ,   Employment Information Form

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: In response to Executive Order 13658, the Department has proposed to add regulations 29 CFR 10.41 that includes an information collection requirement. The proposal would result an increase in burden from additional filings.

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Annual Cost to Federal Government: $632,394

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/17/2014

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