Information Collection

Notice to Employee of FMLA Designation (Federal)

IC 187078 under ICR 201507-1235-001 · OMB 1235-0003.

⚠️ Notice: This information collection may be referencing outdated material.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 (Federal) 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

View Information Collection (IC)

IC Title:	Notice to Employee of FMLA Designation (Federal)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

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

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: 67	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,802	3,802
Annual IC Time Burden (Hours)	634	634
Annual IC Cost Burden (Dollars)	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.