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DOL Issues New FMLA Forms and Poster

    Client Alerts
  • December 12, 2008

As part of its final Family and Medical Leave rules revisions, the Department of Labor replaced or revised all of its forms used by employers to provide notice of FMLA rights, and to seek medical certification of the need for FMLA leave.  The new forms are as follows:

  • Certification of Healthcare Provider (WH-380E and 380F).  DOL released two new medical certification forms, one for an employee’s own serious health condition, and one for companion leave.  The forms allow the employer to ask for more specific medical information, including a formal diagnosis.
  • Notice of Eligibility and Rights and Responsibilities (WH-381).  This combined form is provided within five business days of a request for FMLA leave.  It informs employees whether they qualify for FMLA leave in general, and explains basic rights and responsibilities.
  • Designation Notice to Employee of FMLA Leave (WH-382).  This form is given to the employee within five days of confirmation (usually after the medical certification form is returned) that the FMLA request qualifies for leave.
  • Certification of Qualifying Exigency for Military Family Leave (WH-384).  Used to certify that a family member of a reservist or National Guard member called to active duty qualifies for leave.
  • Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (WH-385).  Includes information certifying requesting employee as qualifying next of kin.

In addition to the new forms, DOL revised its Notice of Employee Rights and Responsibilities form (WH Publication 1420).  This new notice serves both as the required posting of employee FMLA rights, and as the form employee notice for inclusion in employee handbooks or as a stand-alone policy distributed at the time of hiring.  The new rules allow this notice to be electronically posted in most circumstances.

Employers should stop using old DOL FMLA forms as of January 16, 2009.  All of the new forms and notices are listed as appendices to the new FMLA rules.  They can be found at