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SUBJECT: FAMILY MEDICAL LEAVE ACT (E) PAGE ~~ t~,p~ <br />PAGk l~ JF" l9 <br />PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT <br />If :rubmitteci, it au mandatory for employers to retain a copy of this <br />disclasurc irr their records for three years. 29 U.S.C. § 2616;29 G.F.K. § <br />8z5.50G. Persons are not. xequared to respond to this collection of <br />information unless it displays a currently valid OMB control number. "T'he <br />Department of Labor estimate:, that it will take an average of zn manures for <br />res}randents to complete this collection of information, including thc~ timer <br />far reviewing i.nstructi.ons, searching existing data sour-ccs, gathering and <br />maintaining the data needed, grid canrpletang and reviewing tkie collection of <br />information. If you have any comments regarding this burden esti..mate or an~,~ <br />other aspect of this collection information, including suggestions far <br />reducing this burden, send them to the Admini.atrator, wage and Hour Division, <br />U.S. Department of Labor, Roam 5-3502, 200 Constitution Ave:., NW, war~kiingt:on, <br />DC 2G21Q. DO NOT SEND COMPLETED FORD! TO THE DEPARTMENT OF LABOR; RETURN TO <br />THE PATIENT <br />