Information Collection

Employment Information Form

IC 13616 under ICR 201510-1235-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form WH-3-Sp Employment Information Form	Form and Instruction
How to file a complaint - Haitian Creole.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Hait.pdf	Instruction
How to file a complaint- Vietnamese.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Viet.pdf	Instruction
How to file a complaint- Russian.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Russian.pdf	Instruction
How to file a complaint- Thai.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Thai.pdf	Instruction
How to file a complaint- Tagalog.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_TAGALOG.pdf	Instruction
How to file a complaint- Polish.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Polish.pdf	Instruction
How to file a complaint- Chinese.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_CHINESE.pdf	Instruction
How to file a complaint- Korean.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Korean.pdf	Instruction
How to file a complaint- Spanish.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Spanish.pdf	Instruction
How to file a complaint- English.pdf www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint.pdf	Instruction
How to file a complaint- English.pdf www.dol.gov/wecanhelp/howtofilecomplaint.htm	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: 20 CFR 655.1200(b) 29 CFR 5.6 29 CFR 4.191 29 CFR 825.401 41 CFR 50-201.1202 29 CFR 501.1(c) 29 CFR 500.1(e) 29 CFR 801.7(a)(3) 29 CFR 501.5 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of 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
Instruction			How to file a complaint - Haitian Creole.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Hait.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Vietnamese.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Viet.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Russian.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Russian.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Thai.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Thai.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Tagalog.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_TAGALOG.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Polish.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Polish.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Chinese.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_CHINESE.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Korean.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Korean.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- Spanish.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint_Spanish.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- English.pdf	http://www.dol.gov/whd/flsa/WHD1498HowToFileAComplaint.pdf	Yes	No	Printable Only
Instruction			How to file a complaint- English.pdf	http://www.dol.gov/wecanhelp/howtofilecomplaint.htm	Yes	No	Printable Only

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: 35,350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	35,350	35,350
Annual IC Time Burden (Hours)	11,783	11,783
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.