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Employee Screener Survey
Family and Medical Leave Act, Wave 4 Surveys
OMB: 1290-0015
IC ID: 226163
OMB.report
DOL/OS
OMB 1290-0015
ICR 201907-1290-001
IC 226163
( )
Documents and Forms
Document Name
Document Type
FMLA Wave 4 Surveys_OMB Attachment A.1_Employee Screener Survey_7.25.17.docx
Other-Survey
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Employee Screener Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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-Survey
FMLA Wave 4 Surveys_OMB Attachment A.1_Employee Screener Survey_7.25.17.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
8,864
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
8,864
0
0
0
0
8,864
Annual IC Time Burden (Hours)
295
0
0
0
0
295
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
