DOL Form WH-380

View WHD's Form WH-380 Online htm

Agency:

WHD

Title:

Family and Medical Leave Act of 1993 (Certification of Health Care Provider)

Form Description:

The Certification of Health Care Provider is an optional form that an employer may use if it chooses to require certification from a health care provider that a serious health condition requiring leave under the Family and Medical Leave Act (FMLA) exists.

OMB Control Number:

1215-0181