Information Collection

Employment Information Form

IC 13616 under ICR 201409-1235-001 · OMB 1235-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0021 can be found here:

Documents and Forms

Document Name Document Type
Form WH-3-Sp Employment Information Form Form and Instruction
WH-3-Sp Employment Information Form Spanish wh3Sp.pdf Form and Instruction
WH-3 Employment Information Form wh3.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employment Information Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 500.1(e) 29 CFR 801.7(a)(3) 29 CFR 825.401 41 CFR 50-201.1202 29 CFR 501.1(c) 29 CFR 501.5 20 CFR 655.1200(b) 29 CFR 5.6 29 CFR 4.191 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-3-Sp	Employment Information Form Spanish	wh3Sp.pdf		No		Paper Only
Form and Instruction	WH-3	Employment Information Form	wh3.pdf		No		Paper Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35,350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35,350	350	35,000
Annual IC Time Burden (Hours)	11,783	116	11,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.