5 FMLA Forms

Introduction to FMLA Forms

The Family and Medical Leave Act (FMLA) is a federal law that provides eligible employees with up to 12 weeks of unpaid leave in a 12-month period for certain family and medical reasons. To facilitate the leave process, the U.S. Department of Labor has created several forms that employers and employees must use to certify the need for leave and to notify the employer of the intention to take leave. In this article, we will discuss the 5 main FMLA forms and their purposes.

FMLA Form 1: WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition

The WH-380-E form is used to certify an employee’s serious health condition. This form must be completed by the employee’s healthcare provider and returned to the employer. The form requires the healthcare provider to provide information about the employee’s condition, including the date the condition commenced, the probable duration of the condition, and the appropriate medical facts within their knowledge.

FMLA Form 2: WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition

The WH-380-F form is similar to the WH-380-E form but is used to certify a family member’s serious health condition. This form is completed by the family member’s healthcare provider and is used to support an employee’s request for leave to care for a family member with a serious health condition.

FMLA Form 3: WH-381 Notice of Eligibility and Rights & Responsibilities

The WH-381 form is used by employers to notify employees of their eligibility for FMLA leave and their rights and responsibilities under the law. This form must be provided to the employee within 5 business days of the employee’s request for leave. The form outlines the employee’s eligibility for leave, the amount of leave available, and the requirements for taking leave.

FMLA Form 4: WH-382 Designation Notice

The WH-382 form is used by employers to notify employees whether their leave has been designated as FMLA leave. This form must be provided to the employee within 5 business days of the employer’s receipt of sufficient information to determine whether the leave is eligible under the FMLA. The form will indicate whether the leave has been approved or denied and will provide the employee with information about their rights and responsibilities during the leave period.

FMLA Form 5: WH-384 Certification of Qualifying Exigency for Military Family Leave

The WH-384 form is used to certify a qualifying exigency for military family leave. This form is completed by the employee and is used to support a request for leave due to a qualifying exigency related to a family member’s military service. The form requires the employee to provide information about the qualifying exigency and to certify that the leave is necessary due to the exigency.

📝 Note: Employers must keep a record of all FMLA forms and supporting documentation for at least 3 years in case of an audit or investigation.

Form Number	Form Name	Purpose
WH-380-E	Certification of Health Care Provider for Employee’s Serious Health Condition	To certify an employee's serious health condition
WH-380-F	Certification of Health Care Provider for Family Member’s Serious Health Condition	To certify a family member's serious health condition
WH-381	Notice of Eligibility and Rights & Responsibilities	To notify employees of their eligibility for FMLA leave and their rights and responsibilities
WH-382	Designation Notice	To notify employees whether their leave has been designated as FMLA leave
WH-384	Certification of Qualifying Exigency for Military Family Leave	To certify a qualifying exigency for military family leave

In summary, the 5 main FMLA forms are used to facilitate the leave process and to ensure that employees and employers are aware of their rights and responsibilities under the law. By understanding the purposes and requirements of each form, employers and employees can navigate the FMLA leave process with confidence.