FMLA Forms

If you are taking a protected leave of absence from work under the Family and Medical Leave Act (FMLA), you may need to fill out FMLA forms to satisfy your employer’s requirements. The act was signed into law by President Clinton in February 1993. It requires that certain employers allow eligible employees access to unpaid time off for specific family and medical reasons. You need to review the FMLA eligibility checklist and fill out the FMLA application, consisting of the Family Medical Leave Act forms.

Key Takeaways

  • FMLA provides unpaid leave that guarantees your job. 
  • You and your employer must complete the appropriate paperwork to take FMLA. 
  • The U.S. Department of Labor’s Wage and Hour Division (DOL-WHD) is in charge of the FMLA program.
  • Some qualifying reasons for taking FMLA leave are pregnancy, adoption, personal illness, and care for military or veteran family members.

How the Family Medical Leave Act Works

The FMLA applies to public and private employees who have worked with the same employer for more than 1,250 hours over the past year. The act limits its scope to employers with more than 50 employees and also excludes—or limits—specific categories of upper-level employees.

It allows eligible employees to be out of work for up to 12 weeks—without pay—when they experience a qualifying need. Situations include caring for an ill family member, tending to a new child—by birth or adoption—and recovering from a serious injury or illness. The types of qualified medical and family purposes include adoption, pregnancy, foster care placement, family or personal illness, or caring for a military or veteran family member.

You can request FMLA for events in an active duty service member's life, such as a short-notice deployment, ceremonies, childcare, rest and recuperation leave from a combat tour, or caring for their parents while they are gone.

The U.S. Department of Labor’s Wage and Hour Division (DOL-WHD) oversees the FMLA program. It has designated seven different FMLA application forms aligned to the reason for the qualified leave and how much information your employer requires to approve or deny the request. You can download forms from the DOL-WHD website. Also, your human resource officer can help you locate the correct request application for your situation.

Below are descriptions of the various forms, the information asked for each type of leave, and how to apply for FMLA.

FMLA Form WH-380-E for Employee Health Condition

Your employer can use Form 380-E (Certification of Health Care Provider for Employee's Serious Health Condition) to obtain a medical certification of your need to leave work. This form has two sections, one that your employer will complete, and one for your doctor or health care provider to complete.

Your human resource office will usually give you the partially-completed form for your healthcare provider to complete.

It covers information about your condition, including:

  • When it began
  • How long it might last
  • Whether your condition has required an overnight stay in a medical facility, and if so, when
  • Which job responsibilities your condition prevents you from fulfilling
  • Your symptoms, diagnosis, and treatment regimen
  • How much time off you need, and whether it will be continuous or sporadic
  • Whether your condition will require follow-up treatment that will require you to miss work

FMLA Form WH-380-F for Family Health Condition

You can use Form 380-F (Certification of Health Care Provider for Family Member's Serious Health Condition) to tell your employer that you need to take leave to care for a seriously ill or injured family member. You’ll need to provide your family member’s name and your relationship to that family member (only certain relatives qualify).

You’ll also need to describe the type of care you must provide and how much time off you will need. This form, like 380-E, requires the employer, employee, and health care practitioner to complete specific information.

Your relative’s medical provider must complete the rest of the form with information similar to that required by Form 380-E, such as:

  • When the condition began
  • How long might it last
  • What type of care your relative needs and other important medical information such as the schedule of care

The idea is to explain why your absence from work is necessary.

WH-380F Employee Section

FMLA Form WH-381 Eligibility and Rights

Form 381 (Notice of Eligibility & Rights and Responsibilities) is a notification document that your employer may give you within five business days of receiving the notice of your intent to take an FMLA leave. This form confirms the information you provided to your employer, including the dates and reason for your leave. You don’t need to complete any part of this form.

However, depending on how your employer completes this form, you might need to take additional steps. If your employer uses this form to confirm and approve your leave, there’s nothing more to do. But your employer might use this form to request that you submit one of the other reports described in this article to:

  • Certify your need to take leave
  • Request proof of your relationship to the family member you’re requesting leave to care for
  • Document military family leave

It may also say that you need to take the steps necessary to maintain your health insurance during your leave. Additionally, you might be required to periodically report to your employer during your leave to let them know when and if you expect to return to work.

The FMLA protects your job while you are on leave, but because it is unpaid time off (up to 12 weeks), many families cannot afford to take it.

FMLA Form WH-382 Designation Notice

There are several reasons why your employer might hand you Form 382 (Designation Notice). There’s nothing for you to fill out yourself, but if your employer uses this form to ask for additional information to determine whether your leave request is valid, you’ll need to take steps to provide that information.

If your employer is using this form to tell you that they are requesting a second or third medical opinion of your ability to work, you’ll need to make arrangements for that medical appointment. Your employer is required to foot the bill for these opinions.

FMLA Form WH-384 for Military Family Leave

Your employer can ask you to complete Form 384 (Certification for Military Family Leave for Qualifying Exigency) to prove your need to take leave under the FMLA’s special provisions for military service members and their families. For example, you might need time off to make financial and child-care arrangements pending your spouse’s deployment.

You’ll need to specifically state why you’re requesting leave and provide proof in the form of the service member’s active duty orders or other acceptable documentation.

Form WH-384 Section II is much more lengthy than other forms. First, you'll need to fill out your name and relationship to the service member.

wh384 section II

Next, you provide the service member's active duty service dates and a copy of their orders or other official documentation.

Wh384 instructions

Then, provide the event that requires you to take FMLA in question five. Question six asks you to check a box certifying what documentation is available.

WH384 instructions

Questions seven through 10 require dates and estimates of work schedules or periods of absence.

WH384 instructions

Questions 11 and 12 ask for more estimates or whether the member is on Rest and Recuperation leave.

WH384 Instructions

Finally, you provide your information, and sign and date the request.

WH384 instructions

FMLA Form WH-385 for Servicemember Care

Use Form 385 (Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave) to request leave to care for a sick or injured service member. You will use WH-385 to provide details about the individual you will be caring for, including your relationship with that person.

WH-385 instructions

Next, you'll fill out the servicemember's status, the care you'll provide, an estimate of the amount of leave needed, and a reduced work schedule.

WH385 instructions

Following that, you’ll need to give the form to the service member’s qualified health provider (such as a Department of Defense doctor) to complete the sections of the form about the service member’s condition and treatment.

FMLA Form WH-385-V for Veteran Caregiver Leave

If you need to take leave to care for a veteran who is seriously ill or injured and requires your care, your employer might give you Form 385-V (Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave). You must provide the veteran’s name and your relationship to them—leave may only be granted if you are their spouse, child, parent, or next of kin.

wh385v instructions

You’ll also need to fill out the date of the veteran’s discharge, indicate whether the veteran was dishonorably discharged, provide the veteran’s rank and branch at the time of discharge, and check the box indicating whether they are receiving medical treatment for an injury or illness. You must then describe the type of care you need to provide and how much time you need to provide it.

wh385v instructions

After that, you'll give the form to the veteran’s qualified health provider (such as a U.S. Department of Defense doctor) and ask them to complete the form's sections about the veteran’s condition and treatment.

Frequently Asked Questions

What Conditions Qualify for FMLA Leave?

It depends on which type of leave you're applying for. Inpatient care, incapacity, pregnancy, chronic conditions, long-term or permanent conditions, or conditions requiring multiple treatments qualify. For a family member, active duty servicemember, or veteran, they'll need assistance with care and basic functions, physical care, psychological comfort, or transportation.

Where Do I Send My FMLA Paperwork?

Any paperwork you're required to fill out must be brought back to your employer. The Department of Labor or other government agencies do not approve or disapprove FMLA leave, unless you're employed by one.

How Do I Get Paid While on FMLA?

FMLA leave is extended unpaid leave that guarantees you have a job when the leave is completed.

Can FMLA Leave Be Denied?

FMLA leave can be denied if it is requested for circumstances that are not qualified under the act or if the employee doesn't provide a complete and sufficient certification from a health care provider.

Who Can Fill Out an FMLA Form?

The forms for FMLA leave vary according to whether the employee needs the leave for themselves or to care for family members. The forms must be filled out in the appropriate sections by the employer, employee, and healthcare provider.

The Bottom Line

Some FMLA forms do not require you to fill out the form yourself—they require you to take specific steps to prove your need for taking leave or provide information about how long you’ll miss work. Usually, an employer or doctor fills out most of the forms. Others require you to fill out small sections.

Your employer’s use of these forms is optional, but they can help formalize arrangements between employers and employees to ensure both parties fulfill their rights and responsibilities. And it is worth noting that leave under the FMLA is unpaid unless your company (and not many do) provides paid time off for you to care for family members.

Article Sources
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  1. Economic Policy Institute. "Providing unpaid leave was only the first step; 25 years after the Family and Medical Leave Act, more workers need paid leave."

  2. U.S. Department of Labor. "FMLA Frequently Asked Questions."