Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector)

The Family and Medical Leave Act of 1993, As Amended

OMB: 1235-0003

IC ID: 178568

Information Collection (IC) Details

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Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector)
 
No Unchanged
 
Mandatory
 
29 CFR 825.300(b), (c)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction WH-381 Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act WH-381 02.06.20.docx https://www.dol.gov/whd/forms/WH-381.pdf Yes No Fillable Printable

Workforce Management Labor Rights Management

 

290,304 194,123
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   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 12,067,609 0 0 0 0 12,067,609
Annual IC Time Burden (Hours) 2,011,268 0 0 0 0 2,011,268
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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