OMB control number

29 C.F.R. Part 825, The Family and Medical Leave Act of 1993

OMB 1215-0181 · DOL/ESA.

OMB 1215-0181

Latest Forms, Documents, and Supporting Material

Document Name
Form WH-382 Notice to Employee of FMLA Designation (Federal) Form and Instruction
Form WH-381 Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction
Form WH-382 Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction
Form WH-382 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction
Form WH-381 Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction
Form WH-380-E Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction
1215-0181ss(20081212)[1].doc Supporting Statement A
1215-0181 Note to the Reviewer(2008111).doc Supplementary Document
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal)
Notice to Employee of Pending Cancellation of Health Benefits (Federal)
Notice to Employee of FMLA Designation (Federal) Form and Instruction
Key Employee Notification (Federal)
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal)
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction
General FMLA Recordkeeping (Federal)
Key Employee Notification (State, local, tribal)
General FMLA Recordkeeping (State, local, tribal)
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector)
Documenting Family Relationship
Periodic Employee Status Report
Notice to Employee of FMLA Designation (Private Sector) Form and Instruction
General FMLA Recordkeeping (Private Sector)
Key Employee Notification (Private Sector)
Fitness-For-Duty Medical Certifications
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector)
Written Guidance to Employees of FMLA Rights (Handbooks/Manuals)
Employee's Notice of Need for FMLA Leave
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction

All Historical Document Collections

200810-1215-003 Approved with change	Revision of a currently approved collection	2008-11-17
200709-1215-004 Comment filed on proposed rule and continue	Revision of a currently approved collection	2008-02-11
200702-1215-001 Approved without change	Extension without change of a currently approved collection	2007-06-14
200406-1215-001 Approved without change	Extension without change of a currently approved collection	2004-06-08
200306-1215-001 Approved without change	Extension without change of a currently approved collection	2003-06-12
200205-1215-002 Approved without change	Extension without change of a currently approved collection	2002-05-24
200001-1215-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2000-01-20
199906-1215-004 Approved without change	Extension without change of a currently approved collection	1999-06-17
199606-1215-001 Approved without change	Revision of a currently approved collection	1996-06-05
199306-1215-002 Approved without change	New collection (Request for a new OMB Control Number)	1993-06-01