Information Collection

Notice to Employee of FMLA Designation (Private Sector)

IC 182081 under ICR 202605-1235-003 · OMB 1235-0003.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-382 Designation Notice under the Family and Medical Leave Act Notice to Employee of FMLA Designation (Private Sector)	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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-382			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: 261,911

Number of Respondents for Small Entity: 194,123

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,573,035	505,426	12,067,609
Annual IC Time Burden (Hours)	2,095,506	84,238	2,011,268
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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