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 some paperwork 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.
The FMLA Scope
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 gives eligible employees the ability to be out of work for up to 12 weeks—without pay—when they experience a qualifying need. The needs include the care for an ill family member, tending to a new child—both by birth and by adoption,—and to recover from a serious injury or illness. The types of qualified medical and family purposes also include adoption, pregnancy, foster care placement, family or personal illness, or military leave.
The U.S. Department of Labor’s Wage and Hour Division (DOL-WHD) oversees the FMLA program. They have designated seven different FMLA application forms aligned to the reason for the qualified leave and how much information your employer requires in order to approve or deny the request. You can download the form from the DOL-WHD website or by calling them at 1-866-487-9243. Also, your human resource officer can help you locate the correct request application for your situation.
Below, we describe the various forms and the information that is asked for on each.
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 own need to take a leave of absence from work. This form has three sections, one that your employer will complete, one section for you to complete, and the final section is for your doctor or health care provider to complete.
Your human resource office will usually give you the partially-completed form for you 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 the 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 did the condition begin
- 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.
FMLA Form WH-381 Eligibility and Rights
Form 381 (Notice of Eligibility and 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 gave 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 381 may also say that you need to take the steps necessary to maintain your health insurance during your leave. It may also specify that you are required to periodically report back to your employer during your leave to let them know when and if you expect to return to work.
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 is using this form to ask for additional information to determine whether your leave request is valid, you’ll need to take the steps to provide that information.
Also, 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.
(Learn more about workers’ rights in Salary vs. Hourly: How Benefits and Laws Differ.)
FMLA Form WH-384 for Military Family Leave
Your employer can ask you to complete Form 384 (Certification of Qualifying Exigency For Military Family Leave) 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.
This form asks you for information about how long and how often you’ll need to miss work, the name of the military member this request is related to, your relationship to him/her and his/her dates of active duty. 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.
FMLA Form WH-385 for Servicemember Care
Use Form 385 (Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave) to request leave to care for a sick or injured service member. You will use 385 to provide details about the individual you will be caring for, including your relationship to that person and the amount of time off you expect to need.
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 have them 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 want 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, the parent, or the next of kin.
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 the amount of time you need off to provide that care. After that, you'll give the form to the veteran’s qualified health provider (such as a Department of Defense doctor) and ask them to complete the sections of the form about the veteran’s condition and treatment.
The Bottom Line
Most FMLA forms do not require you to fill out the form yourself — they require you to take certain steps to prove your need for taking leave or provide information about how long you’ll miss work. It is usually an employer or doctor who fills out the majority of the form. Your employer’s use of these forms is optional, but they can be helpful in formalizing arrangements between employers and employees to ensure both parties fulfill their rights and responsibilities.
(To learn more about the Family and Medical Leave Act, read How FMLA Works and Protects Your Job.)