Family and Medical Leave Act of 1993, As Amended

ICR 201410-1235-004

OMB: 1235-0003

Federal Form Document

IC Document Collections
IC ID
Document
Title
Status
187163
Modified
187079
Unchanged
187078 Modified
187073
Modified
186957
Modified
186955 Modified
186913 Modified
186900
Modified
186899 Modified
186898
Modified
186891
Modified
186890
Modified
182234
Modified
182233
Modified
182083
Modified
182081 Modified
178656
Modified
178655
Modified
178653
Modified
178607
Modified
178568 Modified
13897 Modified
ICR Details
1235-0003 201410-1235-004
Historical Active 201408-1235-001
DOL/WHD
Family and Medical Leave Act of 1993, As Amended
Revision of a currently approved collection   No
Regular
Approved with change 05/08/2015
Retrieve Notice of Action (NOA) 02/25/2015
  Inventory as of this Action Requested Previously Approved
05/31/2018 36 Months From Approved 05/31/2015
82,371,724 0 89,305,469
9,313,503 0 19,027,093
184,932,912 0 163,467,915

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). 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
  
None

1235-AA09 Final or interim final rulemaking 80 FR 9989 02/25/2015

  79 FR 54299 11/11/2014
80 FR 10162 02/25/2015
Yes

22
IC Title Form No. Form Name
Notice to Employee of FMLA Designation (Federal) WH-382 Designation Notice (Family and Medical Leave Act)
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)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) WH-381 Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
Notice to Employee of FMLA Designation (State, local, tribal) WH-382 Designation Notice (Family and Medical Leave Act)
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) WH-381 Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)
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 Designation Notice (Family and Medical Leave Act)
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-380-F, WH-385-V, WH-380-E Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act) ,   Certification of Qualifying Exigency for Military Family Leave (Family and Medical Leave Act) ,   Certification for Serious Injury or Illness of a Current Servicemember - - for Military Family Leave (Family and Medical Leave Act) ,   Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) ,   Certification for Serious Injury or illness of a Veteran for Military Caregiver Leave (Family and Medical Leave Act)
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) WH-381, WH-381 Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act) ,   Notice of Eligibility and Rights and Responsibilities (Family and Medical Leave Act)

  Total Approved 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 82,371,724 89,305,469 0 38,102 -6,971,847 0
Annual Time Burden (Hours) 9,313,503 19,027,093 0 4,918 -9,718,508 0
Annual Cost Burden (Dollars) 184,932,912 163,467,915 0 108,326 21,356,671 0
Yes
Changing Regulations
No
There is a slight increase upon existing responses, burden hours, and burden costs associated with this final rule. The changed paperwork burden estimates stem from two fundamental changes. First, the expansion of FMLA leave to employees to care for same-sex spouses and the stepchildren or stepparents of same-sex spouses, regardless of their state of residence. Second, increased wage rates for persons completing the information collections and other higher costs, as discussed in Item 13 of the supporting statement. The federal costs have also increased, in spite of utilizing double-sided printing, due to increases in postage prices. However, the respondents, responses, burden hours, and burden costs will now appear to be significantly lower than in the most recent FMLA rulemaking supporting statement. These changes principally stemmed from the Department's detection of the duplicative counting of respondents in an earlier rulemaking. This supporting statement has corrected those mathematical equations. Because some of those calculations result in different numbers of responses, burden hours and burden costs, the Department has carefully detailed the basis and steps to its current computations. Another change to this supporting statement, also for the purposes of clarity and transparency, is more clearly detailing the Department's attribution of hours and costs to employees, health care providers, and employers, respectively.

$784,860
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.
02/25/2015


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