Notice to Employee of FMLA Designation (Private Sector)

The Family and Medical Leave Act of 1993, As Amended

Documents and Forms

Document Name Document Type
Form WH-382 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction
Form WH-382 Notice to Employee of FMLA Designation (Private Sector) Form and Instruction
WH-382 Designation Notice under the Family and Medical Leave Ac WH-382 02.05.20.docx www.dol.gov/whd/forms/WH-382.pdf Form and Instruction
WH-382 Designation Notice under the Family and Medical Leave Ac WH-382 02.05.20.docx www.dol.gov/whd/forms/WH-382.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Notice to Employee of FMLA Designation (Private Sector)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 825.127(c)(4) 29 CFR 825.300(d) 29 CFR 825.301 29 CFR 825.305(c) 29 CFR 825.312

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	WH-382	Designation Notice under the Family and Medical Leave Act	WH-382 02.05.20.docx	https://www.dol.gov/whd/forms/WH-382.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 290,304	Number of Respondents for Small Entity: 194,123

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,067,609	497,454	11,570,155
Annual IC Time Burden (Hours)	2,011,268	82,909	1,928,359
Annual IC Cost Burden (Dollars)	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.