Notice to Employee of FMLA Designation (State, local, tribal)

Family and Medical Leave Act of 1993, As Amended

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0003 can be found here:

Documents and Forms

Document Name Document Type
Form WH-382 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction
WH-382 Designation Notice (Family and Medical Leave Act) WH-382 Designation Notice draft 2014.pdf www.dol.gov/whd/forms/WH-382.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Notice to Employee of FMLA Designation (State, local, tribal)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 825.301 29 CFR 825.127(c)(4) 29 CFR 825.312 29 CFR 825.305(c) 29 CFR 825.300(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-382	Designation Notice (Family and Medical Leave Act)	WH-382 Designation Notice draft 2014.pdf	http://www.dol.gov/whd/forms/WH-382.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 89,499	Number of Respondents for Small Entity: 70,488

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,198,798	2,128	-325,294	4,521,964
Annual IC Time Burden (Hours)	699,800	354	-520,249	1,219,695
Annual IC Cost Burden (Dollars)	0	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.