Employee Polygraph Protection Act

OMB 1235-0005

These third-party notifications and recordkeeping requirements help ensure polygraph examinees receive the protections and rights provided by the Employee Polygraph Protection Act (EPPA).

The latest form for Employee Polygraph Protection Act expires 2023-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form WH-1481 Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances Form
1235 - 0005 Calculations.xlsx Supplementary Document
SS 1235-0005 v3.6 (2023-08-31).docx Supporting Statement A
60-day FR Notice 1235-0005 (2023-02-28).pdf Supplementary Document
Test Results Written Report and Test Record Maintenance--Employer
Test Results Written Report and Test Record Maintenance--Polygrapher
Written Notice of Test Results Prior to Adverse Employment Action
Notice to Polygraph Examiner Identifying Persons to be Examined
Notice to Examinee--Ongoing Investigations of Employer's Economic Loss or Injury
Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances Form

All Historical Document Collections

202306-1235-003 Approved without change	Extension without change of a currently approved collection	2023-09-08
202001-1235-001 Approved without change	Extension without change of a currently approved collection	2020-08-14
201701-1235-003 Approved with change	Extension without change of a currently approved collection	2017-06-13
201402-1235-002 Approved without change	Extension without change of a currently approved collection	2014-09-26
201102-1235-001 Approved with change	Revision of a currently approved collection	2011-07-22
201003-1235-005 Approved without change	Extension without change of a currently approved collection	2010-03-12

OMB Details

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

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Form WH-1481

Notice to Examinee-Employee Polygraph Protection Act

www.dol.gov/whd/forms/wh1481.pdf

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.