Information Collection

Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)

IC 186955 under ICR 202605-1235-003 · OMB 1235-0003.

Documents and Forms

Document Name Document Type
Form WH-381 Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction
WH-381 Notice of Eligibility & Rights and Responsibilities unde WH-381 02.06.20.docx www.dol.gov/whd/forms/WH-381.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 825.300(b), (c)

Information Collection Instruments:

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

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,989	160	3,829
Annual IC Time Burden (Hours)	665	27	638
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.

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