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Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal)

IC 186913 under ICR 202306-1235-001 · OMB 1235-0003.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal)
 
No Modified
 
Mandatory
 
29 CFR 825.300(b), (c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction WH-381 Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act WH-381 02.06.20.docx https://www.dol.gov/whd/forms/WH-381.pdf Yes No Fillable Printable

Workforce Management Labor Rights Management

 

101,731 70,488
   
State, Local, and Tribal Governments
 
   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 4,228,835 0 0 174,322 0 4,054,513
Annual IC Time Burden (Hours) 704,806 0 0 29,054 0 675,752
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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