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Periodic Employee Status Report
The Family and Medical Leave Act of 1993, As Amended
OMB: 1235-0003
IC ID: 182083
OMB.report
DOL/WHD
OMB 1235-0003
ICR 202302-1235-002
IC 182083
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0003 can be found here:
2023-06-06 - No material or nonsubstantive change to a currently approved collection
2023-04-28 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Periodic Employee Status Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
29 CFR 825.311
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
175,682
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
351,364
0
0
0
0
351,364
Annual IC Time Burden (Hours)
11,712
0
0
0
0
11,712
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.