Information Collection

Certification Paid Sick Leave

IC 219203 under ICR 202504-1235-002 · OMB 1235-0029.

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Information Collection (IC) Details

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IC Title:	Certification Paid Sick Leave	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 13.5(e)

Information Collection Instruments:

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

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 188,356	Number of Respondents for Small Entity: 113,014

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	188,356	40,270	148,086
Annual IC Time Burden (Hours)	15,696	3,355	12,341
Annual IC Cost Burden (Dollars)	1,598,951	430,794	1,168,157

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

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