Information Collection

Family and Medical Leave Act Survey- Employee Survey

IC 198931 under ICR 201201-1235-002 · OMB 1235-0026.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0026 can be found here:

Documents and Forms

Document Name Document Type
FMLA OMB Attachment C Employee Survey_Final to OMB _1-25-12.DOC Other-telephone survey
FMLA OMB Attachment A advance letter-employees_Final.doc FMLA OMB Attachment A advance letter employee final IC Document
FMLA OMB Attachment B Privacy Statement_Final.doc FMLA OMB Attachment B Privacy Statement final IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Family and Medical Leave Act Survey- Employee Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 825

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-telephone survey			FMLA OMB Attachment C Employee Survey_Final to OMB _1-25-12.DOC		No		Paper Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,500	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	Previously Approved
Annual Number of Responses for this IC	18,500	18,500
Annual IC Time Burden (Hours)	1,292	1,292
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FMLA OMB Attachment A advance letter employee final	FMLA OMB Attachment A advance letter-employees_Final.doc	01/09/2012
FMLA OMB Attachment B Privacy Statement final	FMLA OMB Attachment B Privacy Statement_Final.doc	01/09/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.