Information Collection

Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances

IC 13874 under ICR 202609-1235-001 · OMB 1235-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form WH-1481 WH-1481 Notice to Examinee Employee Polygraph Protection Act Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances	Form and Instruction
WH-1481 WH-1481 Notice to Examinee Employee Polygraph Protection wh1481 Notice to Examinee- Employee Polygraph Protection Act.pdf www.dol.gov/agencies/whd/forms	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 801.12(a)

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-1481			https://www.dol.gov/agencies/whd/forms	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 82,000

Number of Respondents for Small Entity: 77,080

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	164,000	164,000
Annual IC Time Burden (Hours)	2,733	2,733
Annual IC Cost Burden (Dollars)	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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