OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy

IC 13897 under ICR 201910-1235-001 · OMB 1235-0003.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy
 
No Modified
 
Required to Obtain or Retain Benefits
 
29 CFR 825.213(a)(3) 29 CFR 825.216(b) 29 CFR 825.100(d) 29 CFR 825.307 29 CFR 825.308 29 CFR 825.310 29 CFR 825.306 29 CFR 825.309 29 CFR 825.312 29 CFR 825.305

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction WH-380-F Certification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave Act WH-380-F 02.06.20.docx https://www.dol.gov/whd/forms/wh-380-f.pdf Yes No Fillable Printable
Form and Instruction WH-380-E Certification of Health Care Provider for Employee's Serious Health Condition under the Family and Medical Leave Act WH-380-E 02.06.20.docx https://www.dol.gov/whd/forms/WH-380-E.pdf Yes No Fillable Printable
Form and Instruction WH-385 Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave under the Family and Medical Leave Act WH-385 02.06.20.docx https://www.dol.gov/whd/forms/WH-385.pdf Yes No Fillable Printable
Form and Instruction WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave under the Family and Medical Leave Act WH-385-V 02.06.20.docx https://www.dol.gov/whd/forms/wh385v.pdf Yes No Fillable Printable
Form and Instruction WH-384 Certification for Military Family Leave for Qualifying Exigency under the Family and Medical Leave Act WH-384 02.06.20.docx https://www.dol.gov/whd/forms/WH-384.pdf Yes No Fillable Printable

Workforce Management Labor Rights Management

 

6,889,489 0
   
Individuals or Households
 
   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 9,373,687 0 0 0 0 9,373,687
Annual IC Time Burden (Hours) 2,228,773 0 -666,491 0 0 2,895,264
Annual IC Cost Burden (Dollars) 185,726,276 0 -7,806,542 0 0 193,532,818

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