Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)

The Family and Medical Leave Act of 1993, As Amended

OMB: 1235-0003

IC ID: 186900

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Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal)
 
No Unchanged
 
Mandatory
 
29 CFR 825.212(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Workforce Management Labor Rights Management

 

50,866 35,244
   
State, Local, and Tribal Governments
 
   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 50,866 0 0 0 0 50,866
Annual IC Time Burden (Hours) 4,239 0 0 0 0 4,239
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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