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Key Employee Notification (Federal)
Family and Medical Leave Act of 1993, As Amended
OMB: 1235-0003
IC ID: 187073
OMB.report
DOL/WHD
OMB 1235-0003
ICR 201410-1235-004
IC 187073
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0003 can be found here:
2023-06-06 - No material or nonsubstantive change to a currently approved collection
2023-04-28 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Key Employee Notification (Federal)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
29 CFR 825.219
29 CFR 825.300(c)(1)(v)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
11
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
11
0
0
0
0
11
Annual IC Time Burden (Hours)
1
0
0
0
0
1
Annual IC Cost Burden (Dollars)
0
0
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.