News and Information

USDOL Updates FMLA Notice and Certification Forms

The U.S. Department of Labor (USDOL) has updated optional-use Family and Medical Leave Act (FMLA) forms. Under the FMLA, covered employers must provide employees with certain required notices. Employers may use their own forms, if they provide the required notice information, or they may use the following optional forms developed by the USDOL to reduce the amount of time it takes a healthcare provider to provide information, and to help the leave administrator review and communicate information to employee more directly and with greater clarity. For more information, go to the USDOL site, or click on the links below to access specific forms.

Notice Forms For more information on notification requirements, see WHD Fact Sheet #28D: Employer Notification Requirements Under the Family and Medical Leave Act.

• Form WH-381 (Eligibility Notice, and Rights and Responsibilities Notice) for employer to inform employee of eligibility for FMLA leave or at least one reason of ineligibility, as well as the specific obligations associated with FMLA leave and the consequences of failing to meet those obligations.
• Form WH-382 (Designation Notice) for employer to inform employee whether the FMLA leave request is approved, whether additional information is needed, and how much of the leave is counted against the employee’s FMLA entitlement.

Certification Forms Certification is an optional tool for employers to request information to support an employee’s need for leave for an FMLA qualifying reason. Forms include:

• Certification of Healthcare Provider for a Serious Health Condition:
  • Form WH-380-E (Employee’s serious health condition)
  • Form WH-380-F (Family member’s serious health condition)
• Certification of Military Family Leave:
  • Form WH-384 (Qualifying Exigency) when leave request arises out of the foreign deployment of the employee’s spouse, son, daughter or parent
  • Form WH-385 (Military Caregiver Leave of a Current Servicemember)
  • Form WH-385-V (Military Caregiver Leave of a Veteran)