Information Collection

Employer Screener Survey

IC 226267 under ICR 201703-1290-001 · OMB 1290-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1290-0015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FMLA Wave 4 Surveys_OMB Attachment B.1_Employer Screener Survey_7.25.17.docx	Other-Employer Screener Survey

IC Title:

Employer Screener Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Other-Employer Screener Survey			FMLA Wave 4 Surveys_OMB Attachment B.1_Employer Screener Survey_7.25.17.docx		No		Printable Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,044

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,044	3,044
Annual IC Time Burden (Hours)	203	203
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.