OMB control number

Employee Polygraph Protection Act

OMB 1235-0005 · DOL/WHD.

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 2026-10-31 and is listed under ICR 202306-1235-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
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	Information collection
Test Results Written Report and Test Record Maintenance--Polygrapher	Information collection
Written Notice of Test Results Prior to Adverse Employment Action	Information collection
Notice to Polygraph Examiner Identifying Persons to be Examined	Information collection
Notice to Examinee--Ongoing Investigations of Employer's Economic Loss or Injury	Information collection
Notice to Examinee Applicable to Certain Ongoing Investigations, Security Services, and Security of Controlled Substances	Form

All Historical Document Collections

Historical document collections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

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

Information collection instruments
Form	Name	Electronic access	Type
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.