Employer Screener Survey

Family and Medical Leave Act, Wave 4 Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1290-0015 can be found here:

Documents and Forms

Document Name Document Type
FMLA Wave 4 Surveys_OMB Attachment B.1_Employer Screener Survey_7.25.17.docx Other-Employer Screener Survey

Information Collection (IC) Details

IC Title:	Employer Screener Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Employer Screener Survey			FMLA Wave 4 Surveys_OMB Attachment B.1_Employer Screener Survey_7.25.17.docx		No		Printable Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,044	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,044	3,044
Annual IC Time Burden (Hours)	203	203
Annual IC Cost Burden (Dollars)	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.