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

The Family and Medical Leave Act of 1993, As Amended

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: Modified

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,228,835	174,322	4,054,513
Annual IC Time Burden (Hours)	704,806	29,054	675,752
Annual IC Cost Burden (Dollars)	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.