OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

The Family and Medical Leave Act of 1993, As Amended

ICR 202304-1235-001 · OMB 1235-0003 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form WH-382 Notice to Employee of FMLA Designation (Federal) Form and Instruction Unchanged Repair queued
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 Missing upstream
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 Modified Repair queued
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction Modified 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 Repair queued
60-day FR notice 2022-11-09.pdf Supplementary Document Uploaded 2023-04-13 Repair queued
Supporting Statement 1235-0003 (2023-04-24).docx Supporting Statement A Uploaded 2023-04-24 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
187163 Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal) Modified
187079 Notice to Employee of Pending Cancellation of Health Benefits (Federal) Modified
187078 Notice to Employee of FMLA Designation (Federal) Form and Instruction Unchanged
187073 Key Employee Notification (Federal) Modified
186957 Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal) Modified
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
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
186898 General FMLA Recordkeeping (Federal) Unchanged
186891 Key Employee Notification (State, local, tribal) Unchanged
186890 General FMLA Recordkeeping (State, local, tribal) Modified
182234 Notice to Employee of Pending Cancellation of Health Benefits (Private Sector) Modified
182233 Documenting Family Relationship Modified
182083 Periodic Employee Status Report Unchanged
182081 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction Modified
178656 General FMLA Recordkeeping (Private Sector) Modified
178655 Key Employee Notification (Private Sector) Modified
178653 Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector) Modified
178607 Employee's Notice of Need for FMLA Leave Modified
178568 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) 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
StatusReceived in OIRA
Agency/SubagencyDOL/WHD
OMB Control No1235-0003
Type of Information CollectionExtension without change of a currently approved collection
Previous ICR Reference No202302-1235-002
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31