Information Collection

Wage and Hour Division Family and Medical Leave Act Customer Experience Survey

IC 211911 under ICR 201406-1225-002 · OMB 1225-0088.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0088 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
WHD FMLA_v5.pdf	Other-Mail Survey
FMLA Customer Exp Survey(20140629).docx Supplemental Justification Supporting Statement for Family and Medical Leave Act Customer Experience Survey	IC Document

IC Title:

Wage and Hour Division Family and Medical Leave Act Customer Experience Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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-Mail Survey			WHD FMLA_v5.pdf		No		Paper Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,713

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,713	1,713
Annual IC Time Burden (Hours)	286	286
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supplemental Justification Supporting Statement for Family and Medical Leave Act Customer Experience Survey	FMLA Customer Exp Survey(20140629).docx	06/29/2014

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