Employment Information Form

ICR 202109-1235-001

OMB: 1235-0021

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-10-06
Supplementary Document
2021-10-06
Justification for No Material/Nonsubstantive Change
2020-05-15
Justification for No Material/Nonsubstantive Change
2020-03-29
Supplementary Document
2019-05-21
Supplementary Document
2019-05-21
Supplementary Document
2019-05-21
Supplementary Document
2019-05-21
Supplementary Document
2019-05-21
Supplementary Document
2019-05-21
Supporting Statement A
2021-11-06
IC Document Collections
IC ID
Document
Title
Status
236191 Removed
13616 Modified
ICR Details
1235-0021 202109-1235-001
Received in OIRA 202005-1235-001
DOL/WHD
Employment Information Form
Revision of a currently approved collection   No
Regular 11/24/2021
  Requested Previously Approved
11/30/2022 11/30/2022
38,244 38,125
12,748 12,771
0 2

WHD staff use Form WH-3 as a guide for obtaining information complainants (e.g., current and former employees, unions, and competitor employers) voluntarily provide about alleged violations of agency-administered labor standards. Complainants generally provide the information requested on the form to WHD staff over the telephone or in person. WHD staff use the information to determine whether the agency has jurisdiction to investigate the alleged violation(s). When the WHD schedules a complaint-based investigation, the agency makes the completed Form WH-3 part of the investigation case file. Where the information provided does not support a potential WHD enforcement action, complainants are advised and referred to the appropriate agency for further assistance.

US Code: 29 USC 2616(a) Name of Law: Family and Medical Leave Act
   US Code: 29 USC 1862(a) Name of Law: Migrant and Seasonal Agricultural Worker Protection Act
   US Code: 15 USC 1676 Name of Law: Consumer Credit Protection Act
   US Code: 40 USC 3141 Name of Law: Davis Bacon Act
   US Code: 41 USC 38 Name of Law: Walsh-Healey Public Contracts Act
   US Code: 41 USC 353(a) Name of Law: McNamara-O'Hara Service Contract Act
   US Code: 8 USC 1188(g) Name of Law: Immigration and Nationality Act
   EO: EO 13658 Name/Subject of EO: Establishing a Minimum Wage for Contractors
   EO: EO 13706 Name/Subject of EO: Establishing Paid Sick Leave for Contractors
   US Code: 29 USC 211(a) Name of Law: Fair Labor Standards Act
   PL: Pub.L. 116 - 127 110 Name of Law: Families First Coronavirus Response Act
   PL: Pub.L. 116 - 127 5105 Name of Law: Families First Coronavirus Response Act
   US Code: 19 USC 4532 Name of Law: United States-Mexico-Canada Agreement Implementation Act
   US Code: 29 USC 2004(a)(3) Name of Law: Employee Polygraph Protection Act
   EO: EO 14026 Name/Subject of EO: Increasing the Minimum Wage for Federal Contractors
  
PL: Pub.L. 116 - 127 5105 Name of Law: Families First Coronavirus Response Act
PL: Pub.L. 116 - 127 110 Name of Law: Families First Coronavirus Response Act

1235-AA41 Final or interim final rulemaking 86 FR 67126 11/24/2021

  86 FR 38816 07/22/2021
No

1
IC Title Form No. Form Name
Employment Information Form WH-3, WH-3-Sp Employment Information Form Spanish ,   Employment Information Form
PAID WH-1527 PAID certificate

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 38,244 38,125 0 -50 169 0
Annual Time Burden (Hours) 12,748 12,771 0 -79 56 0
Annual Cost Burden (Dollars) 0 2 0 -2 0 0
No
Yes
Miscellaneous Actions
The PAID program has been eliminated which accounts for the reduction in burden due to agency discretion. There is a slight increase to the estimate in complaints due to the final rule which accounts for the change in estimate due to agency adjustment.

$738,015
No
    Yes
    No
No
No
No
No
Robert Waterman 202 693-0805 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/24/2021


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