Notice to Employee of FMLA Designation (State, local, tribal)

The Family and Medical Leave Act of 1993, As Amended

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0003 can be found here:

Documents and Forms

Document Name Document Type
Form WH-382 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction
Form WH-382 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction
WH-382 Designation Notice under the Family and Medical Leave Ac WH-382 02.05.20.docx www.dol.gov/whd/forms/WH-382.pdf Form and Instruction
WH-382 Designation Notice under the Family and Medical Leave Ac WH-382 02.05.20.docx www.dol.gov/whd/forms/WH-382.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Notice to Employee of FMLA Designation (State, local, tribal)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 825.127(c)(4) 29 CFR 825.312 29 CFR 825.305(c) 29 CFR 825.300(d) 29 CFR 825.301

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-382	Designation Notice under the Family and Medical Leave Act	WH-382 02.05.20.docx	https://www.dol.gov/whd/forms/WH-382.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 101,731	Number of Respondents for Small Entity: 70,488

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,054,513	4,054,513
Annual IC Time Burden (Hours)	675,752	675,752
Annual IC Cost Burden (Dollars)	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.