Employment Information Form

ICR 202306-1235-004

OMB: 1235-0035

Federal Form Document

Forms and Documents
Form and Instruction
Supplementary Document
Supporting Statement A
IC Document Collections
260904 New
ICR Details
Received in OIRA
Employment Information Form
New collection (Request for a new OMB Control Number)   No
Regular 09/08/2023
  Requested Previously Approved
36 Months From Approved
28,824 0
9,608 0
0 0

WHD staff use Form WH-3 as a guide for obtaining information complainants (e.g., current and former employees, unions, and competitor employers) voluntarily provide about alleged violations of agency-administered labor standards. Complainants generally provide the information requested on the form to WHD staff over the telephone or in person. WHD staff use the information to determine whether the agency has jurisdiction to investigate the alleged violation(s). When the WHD schedules a complaint-based investigation, the agency makes the completed Form WH-3 part of the investigation case file. Where the information provided does not support a potential WHD enforcement action, complainants are advised and referred to the appropriate agency for further assistance. This is a duplicate ICR of 1235-0021 to allow the public to comment on NPRM 1235-AA39.

US Code: 29 USC 211 Name of Law: Fair Labor Standards Act
   US Code: 29 USC 2616 Name of Law: Family and Medical Leave Act
   US Code: 29 USC 1862 Name of Law: Migrant and Seasonal Agriculture Worker Protection Act
   US Code: 15 USC 1676 Name of Law: Consumer Credit Protection Act
   US Code: 40 USC 3141 Name of Law: Davis-Bacon Act
   US Code: 41 USC 353 Name of Law: McNamara-O'Hara Service Contract Act
   US Code: 19 USC 4532 Name of Law: U.S.-Mexico-Canada Trade Agreement
   US Code: 29 USC 2004 Name of Law: Employee Polygraph Protection Act
   US Code: 41 USC 38 Name of Law: Walsh-Healey Public Contracts Act
   US Code: 8 USC 1188 Name of Law: Immigration and Nationality Act
   EO: EO 13658 Name/Subject of EO: Establishing a Minimum Wage for Federal Contractors
   EO: EO 13706 Name/Subject of EO: Establishing Paid Sick Leave for Federal Contractors
   EO: EO 14026 Name/Subject of EO: Increasing the Minimum Wage for Federal Contractors

1235-AA39 Proposed rulemaking 88 FR 62152 09/08/2023


IC Title Form No. Form Name
Employment Information form WH-3 English, WH-3 Spanish Employment Information Form ,   Employment Information Form

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 28,824 0 0 0 28,824 0
Annual Time Burden (Hours) 9,608 0 0 0 9,608 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Robert Waterman 202 693-0805 [email protected]


On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

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