OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

The Family and Medical Leave Act of 1993, As Amended

ICR 202302-1235-002 · OMB 1235-0003 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form WH-382 Notice to Employee of FMLA Designation (Federal) Form and Instruction Unchanged Repair queued
Form WH-382 Notice to Employee of FMLA Designation (Federal) Form and Instruction Unchanged Missing upstream
Form WH-381 Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction Unchanged Available
Form WH-381 Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction Unchanged Repair queued
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction Unchanged Available
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction Unchanged Repair queued
Form WH-382 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction Unchanged Available
Form WH-382 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction Unchanged Repair queued
Form WH-382 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction Unchanged Repair queued
Form WH-382 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction Unchanged Repair queued
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction Unchanged Repair queued
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction Unchanged Repair queued
Form WH-385 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 Form and Instruction Modified Available
Form WH-385 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 Form and Instruction Modified Repair queued
Justification for non-material change OCIO comment 2.27.23.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-27 Available
Justification for non-material change OCIO comment 2.27.23.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-02-27 Repair queued
ss1235-0003 20200225.docx Supporting Statement A Uploaded 2020-02-25 Available
ss1235-0003 20200225.docx Supporting Statement A Uploaded 2020-02-25 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
187163 Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal) Unchanged
187079 Notice to Employee of Pending Cancellation of Health Benefits (Federal) Unchanged
187078 Notice to Employee of FMLA Designation (Federal) Form and Instruction Unchanged
187078 Notice to Employee of FMLA Designation (Federal) Form and Instruction Unchanged
187073 Key Employee Notification (Federal) Unchanged
186957 Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal) Unchanged
186955 Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction Unchanged
186955 Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction Unchanged
186913 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction Unchanged
186913 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction Unchanged
186900 Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal) Unchanged
186899 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction Unchanged
186899 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction Unchanged
186898 General FMLA Recordkeeping (Federal) Unchanged
186891 Key Employee Notification (State, local, tribal) Unchanged
186890 General FMLA Recordkeeping (State, local, tribal) Unchanged
182234 Notice to Employee of Pending Cancellation of Health Benefits (Private Sector) Unchanged
182233 Documenting Family Relationship Unchanged
182083 Periodic Employee Status Report Unchanged
182081 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction Unchanged
182081 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction Unchanged
178656 General FMLA Recordkeeping (Private Sector) Unchanged
178655 Key Employee Notification (Private Sector) Unchanged
178653 Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector) Unchanged
178607 Employee's Notice of Need for FMLA Leave Unchanged
178568 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction Unchanged
178568 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction Unchanged
13897 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 Form and Instruction Modified
13897 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 Form and Instruction Modified
ICR Details
StatusActive
Agency/SubagencyDOL/WHD
OMB Control No1235-0003
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No201910-1235-001
Date Submitted to OIRA2023-02-27
Requested Expiration Date1969-12-31