Information Collection

Employee Screener Survey

IC 226163 under ICR 201703-1290-001 · OMB 1290-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1290-0015 can be found here:

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: New

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

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 Agency Discretion
Annual Number of Responses for this IC	8,864	8,864
Annual IC Time Burden (Hours)	295	295
Annual IC Cost Burden (Dollars)	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.