Family and Medical Leave Act (FMLA)
The Family and Medical Leave Act (FMLA) allows an eligible employee to take up to twelve workweeks of leave per rolling twelve-month period for the following qualifying events:
- Incapacity due to pregnancy, prenatal medical care or child birth
- Caring for the employee’s child after birth, or placement for adoption or foster care;
- Caring for the employee’s spouse, child, or parent with a serious health condition; or
- Serious health condition of the employee that makes the employee unable to perform the employee’s job
FMLA Certification Forms
PLEASE NOTE: It is important for an employee to know the policies related to FMLA by his or her employer. The following information is from the United States Department of Labor. Many of the forms below are optional for the employer to utilize. Certification is an optional tool provided by the FMLA for employers to use to request information to support certain FMLA-qualifying reasons for leave. 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.
Please do not send any completed certification forms to the U.S. Department of Labor, Wage and Hour Division. Return completed certifications to the employee to provide to his or her employer.
There are five DOL optional-use FMLA certification forms.
Certification of Healthcare Provider for a Serious Health Condition
- Employee’s serious health condition, form WH-380-E (Spanish) - Use when a leave request is due to the medical condition of the employee.
- Family member’s serious health condition, form WH-380-F (Spanish) - Use when a leave request is due to the medical condition of the employee’s family member.
- Help for health care providers – This flier guides healthcare providers through FMLA rules concerning medical certifications. It’s a handy tool that medical professionals can use to make sure patients’ and family caregivers’ employment is protected as they deal with serious health conditions.
Certification of Military Family Leave
- Qualifying Exigency, form WH-384 (Spanish) – use when the leave request arises out of the foreign deployment of the employee’s spouse, son, daughter, or parent.
- Military Caregiver Leave of a Current Servicemember, form WH-385 (Spanish) – use when requesting leave to care for a family member who is a current service member with a serious injury or illness.
- Military Caregiver Leave of a Veteran, form WH-385-V (Spanish) – use when requesting leave to care for a family member is who a covered veteran with a serious injury or illness.
Questions and Answers About FMLA Forms
Can my employer make changes to the FMLA forms?
Your employer may use the WHD prototype forms or create their own version of the forms containing the same basic information. However, an employer that requests a medical certification may request only information that relates to the serious health condition for which the current need for leave exists, and no information may be required beyond that specified in the FMLA regulations. See 29 CFR 825.306, 29 CFR 825.307, and 29 CFR 825.308.
Do I have to use my employer’s certification forms?
Employers must accept a complete and sufficient certification, regardless of the format. The employer cannot reject a certification that contains all the information needed to determine if the leave is FMLA-qualifying. The employer cannot refuse:
- A fax or copy of the certification;
- A certification that is not completed on the employer’s standard company form; or
- Any other record of the medical documentation, such as a communication on the letterhead of the healthcare provider.
The expiration date of the DOL forms has passed, are they still effective?
Yes. The content of the information contained within the optional-use DOL form is still applicable, regardless of the expiration date. The expiration date on the DOL forms is related to the collection of information as required by the Office of Management and Budget (OMB), and not relevant to the content of the required information.
Where do I send the completed certifications or notices?
Do not send any completed certifications or forms to the U.S. Department of Labor, Wage and Hour Division. The employer should provide the required notices to the employee seeking leave. Completed certification forms should be given to the employee to provide to the employer, as it is the employee’s responsibility to provide the employer with the completed certification.