Records to be kept by Employers - Fair Labor Standards Act (FLSA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form WH-14 Application for Federal Certificate of Age	Form and Instruction	Modified	Available
Form WH-14 Application for Federal Certificate of Age	Form and Instruction	Modified	Available
Form WH-5 Certificate of Training	Form and Instruction	Modified	Available
Form WH-5 Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions	Form and Instruction	Modified	Repair queued
SS 1235-0030 11162020.docx	Supporting Statement A	Uploaded 2020-12-30	Repair queued
29 CFR Parts 500 - 870.pdf	Supplementary Document	Uploaded 2020-12-30	Repair queued
29 USC Sections 201 - 219.pdf	Supplementary Document	Uploaded 2020-12-30	Repair queued
Tip Regulations Under the Fair Labor Standards Act NPRM (1235-0018) (published).pdf	Supplementary Document	Uploaded 2020-12-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237454	Minimum Age Standards - Parental Consent		Modified
237453	Application for Authorized Basic Rate		Modified
237452	Records When Claiming Partial Overtime Exemption for Remedial Education		Modified
237451	Requirements of a Bona Fide Thrift or Savings Plan and a Bona Fide Profit Sharing Plan or Trust		Modified
237450	Recording Schools with WECEP students		Modified
237449	WECEP Written Training Agreement		Modified
237448	Work Experience and Career Exploration Program (WECEP)		Modified
237447	Waiver of Child Labor Provisions for Agricultural Employment of 10 and 11-year-old Minors in Hand Harvesting of Short Season Crops		Modified
237446	Application for Federal Certificate of Age	Form and Instruction	Modified	Application for Federal Certificate of Age
237446	Application for Federal Certificate of Age	Form and Instruction	Modified
237445	General FLSA Records (Public Sector)		Modified
237444	Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions	Form and Instruction	Modified	Certificate of Training
237444	Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions	Form and Instruction	Modified
237443	Written Agreements to Claim Non-Agricultural Student Learner Exemption to Youth Employment Restrictions		Modified
237442	Records on State/Local Government Employees Receiving Compensatory Time		Modified
237441	Records on Workers with Disabilities and Patient Workers Paid Sub-Minimum Wages		Modified
237440	Records on Messengers and Student Learners Paid Sub-Minimum Wages		Modified
237439	Records on Full-time Students Paid Sub-Minimum Wages		Modified
237438	Records on Certain Agricultural Emloyees (Employees)		Modified
237437	Records on Certain Agricultural Employees (Employers)		Modified
237436	Records on Tipped Employees		Modified
237435	Records When Paying Overtime on an "Applicable" or "Authorized" Basic Rate		Modified
237434	Records for Overtime Payments Based on Trip Rate Plans		Modified
237433	Petitions for Review and Reconsideration		Modified
237432	General FLSA Records (Private Sector)		Modified

ICR Details

OMB Control No: 1235-0030	ICR Reference No: 202007-1235-002
Status: Historical Inactive	Previous ICR Reference No: 201908-1235-001
Agency/Subagency: DOL/WHD	Agency Tracking No:
Title: Records to be kept by Employers - Fair Labor Standards Act (FLSA)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/24/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/30/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Records required to be kept by employers to maintain compliance with Fair Labor Standards Act (FLSA) 29 U.S.C. 201 et seq.. This is a proxy created mirroring the collection in 1235-0018 to allow the collection to be considered by OMB for two separate actions simultaneously.

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Authorizing Statute(s): US Code: 29 USC 207(q) Name of Law: Fair Labor Standards Act
   US Code: 29 USC 211(c) Name of Law: Fair Labor Standards Act
   US Code: 29 USC 207(e)(8) Name of Law: Fair Labor Standards Act
   US Code: 29 USC 213(c) Name of Law: Fair Labor Standards Act
   US Code: 29 USC 203(l) Name of Law: Fair Labor Standards Act
   US Code: 29 USC 207(e)(3) Name of Law: Fair Labor Standards Act
   EO: EO 13658 Name/Subject of EO: Establishing a Minimum Wage for Federal Contractors
   EO: EO 13706 Name/Subject of EO: Establishing Paid Sick Leave for Federal Contractors
  

Citations for New Statutory Requirements: US Code: 29 USC 203 Name of Law: Fair Labor Standards Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1235-AA21	Final or interim final rulemaking	85 FR 86756	12/30/2020

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 23

table that charts list of burden

IC Title	Form No.	Form Name
Application for Authorized Basic Rate
Application for Federal Certificate of Age	WH-14	Application for Federal Certificate of Age
General FLSA Records (Private Sector)
General FLSA Records (Public Sector)
Minimum Age Standards - Parental Consent
Petitions for Review and Reconsideration
Recording Schools with WECEP students
Records When Claiming Partial Overtime Exemption for Remedial Education
Records When Paying Overtime on an "Applicable" or "Authorized" Basic Rate
Records for Overtime Payments Based on Trip Rate Plans
Records on Certain Agricultural Emloyees (Employees)
Records on Certain Agricultural Employees (Employers)
Records on Full-time Students Paid Sub-Minimum Wages
Records on Messengers and Student Learners Paid Sub-Minimum Wages
Records on State/Local Government Employees Receiving Compensatory Time
Records on Tipped Employees
Records on Workers with Disabilities and Patient Workers Paid Sub-Minimum Wages
Requirements of a Bona Fide Thrift or Savings Plan and a Bona Fide Profit Sharing Plan or Trust
WECEP Written Training Agreement
Waiver of Child Labor Provisions for Agricultural Employment of 10 and 11-year-old Minors in Hand Harvesting of Short Season Crops
Work Experience and Career Exploration Program (WECEP)
Written Agreements to Claim Agricultural Student Learner Exemption to Youth Employment Restrictions	WH-5	Certificate of Training
Written Agreements to Claim Non-Agricultural Student Learner Exemption to Youth Employment Restrictions

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a duplicate to allow the Department to process multiple agency actions involving 1235-0018. The number of respondents for the recordkeeping requirement is the same as listed at time of NPRM. The Department will combine once all agency actions are final and discontinue this OMB control number (1235-0030).

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/30/2020

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