Information Collection

Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)

IC 206431 under ICR 201701-1210-001 · OMB 1210-0149.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1210-0149 can be found here:

Documents and Forms

Document Name Document Type
FLSA Model Notice with Plans.pdf Other-Model Notice
DOL TR 2013-02.pdf Technical Release 2013-02 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice to Employees of Coverage Options Under FLSA 18B (Private Sector)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Notice			FLSA Model Notice with Plans.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,431,800	Number of Respondents for Small Entity: 5,980,300

Affected Public: Private Sector	Private Sector: Farms, Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 52 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	25,245,528	-47,238,764	72,484,292
Annual IC Time Burden (Hours)	101,403	-273,099	374,502
Annual IC Cost Burden (Dollars)	4,076,395	-8,153,597	12,229,992

Documents for IC

Title	Document	Date Uploaded
Technical Release 2013-02	DOL TR 2013-02.pdf	11/06/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.