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Qualifying Exigency, form WH-384 – use when the leave request arises out of the foreign deployment of the employee’s spouse, son, daughter, or parent.

Family member’s serious health condition, form WH-380-F – use when a leave request is due to the medical condition of the employee’s family member.

Employee’s serious health condition, form WH-380-E – use when a leave request is due to the medical condition of the employee.

There are five DOL optional-use FMLA certification forms.Ĭertification of Healthcare Provider for a Serious Health Condition Return completed certifications to the employee to provide to his or her employer. Department of Labor, Wage and Hour Division. Please do not send any completed certification forms to the U.S. An employee can provide the required information contained on a certification form in any format, such as on the letterhead of the healthcare provider, or official documentation issued by the military. An employer may also use this form to inform the employee that the certification is incomplete or insufficient and additional information is needed.Ĭertification is an optional tool provided by the FMLA for employers to use to request information to support certain FMLA-qualifying reasons for leave. Designation Notice, form WH-382 – informs the employee whether the FMLA leave request is approved also informs the employee of the amount of leave that is designated and counted against the employee’s FMLA entitlement.Rights and Responsibilities Notice, form WH-381 (combined with the Eligibility Notice) – informs the employee of the specific expectations and obligations associated with the FMLA leave request and the consequences of failure to meet those obligations.Eligibility Notice, form WH-381 – informs the employee of his or her eligibility for FMLA leave or at least one reason why the employee is not eligible.

This notice can also be used by employers with eligible employees to satisfy their obligation also to provide FMLA general notice to employees in written leave guidance (e.g., handbook) or individually upon hire.

General Notice, the FMLA poster – satisfies the requirement that every covered employer display or post an informative general notice about the FMLA.

For more information on satisfying the FMLA’s employer notification requirements, see WHD Fact Sheet # 28D: Employer Notification Requirements under the Family and Medical Leave Act.Įmployers can use the following forms to provide the notices required under the FMLA. Notice FormsĮmployers covered by the FMLA are obligated to provide their employees with certain critical notices about the FMLA so that both the employees and the employer have a shared understanding of the terms of the FMLA leave. Alternatively, Employers may use their own forms, if they provide the same basic notice information and require only the same basic certification information. These forms are electronically fillable PDFs and can be saved electronically. The Department has developed optional-use forms which can be used by employers to provide required notices to employees, and by employees to provide certification of their need for leave for an FMLA qualifying reason.