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FMLA: Proposed Forms Revision

The U.S. Department of Labor’s Wage and Hour Division (WHD) publishes seven forms which the public may use free of charge in the administration of the Family and Medical Leave Act (FMLA). On August 5, 2019, the U.S. Department of Labor published a notice announcing a 60-day public comment period on proposed revisions to WHD’s optional-use FMLA forms.

The goal in revising the forms is to increase compliance with the FMLA, improve customer service, and reduce the burden on the public by making the forms easier to understand and use.

WHD drafted revisions with input from the public and is seeking comment on the proposed changes, which include:

  • Fewer questions requiring written responses; replaced by statements that can be verified by simply checking a box
  • Reorganization of medical certification forms to more quickly determine if a medical condition is a serious health condition as defined by the FMLA
  • Clarifications to reduce the demand on health care providers for follow-up information
  • More information on the notification forms to better communicate specific information about leave conditions to employees
  • Changes to the qualifying exigency certification form to provide clarity to employees about what information is required
  • Changes to the military caregiver leave forms to improve consistency and ease of use
  • Layout and style changes to reduce blank space and improve readability

You may view proposed revisions to each of the forms at:

  • WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition
  • WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition
  • WH-381 Notice of Eligibility of Rights & Responsibilities
  • WH-382 Designation Notice
  • WH-384 Certification of Qualifying Exigency for Military Family Leave
  • WH-385 Certification for Serious Injury or Illness of Covered Servicemember—for Military Family Leave
  • WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

Supporting Statement

Read our public notice concerning the proposed revisions here. To comment on the proposed revisions, email WHDPRAComments@dol.gov. Comments must be submitted by October 4, 2019. Comments, including any personal information provided, become a matter of public record. They will also be summarized and/or included in the request for Office of Management and Budget (OMB) approval of the information collection request.

The draft revisions are for review and comment only, and are not for use in the administration of the FMLA. You may access the current DOL FMLA forms at www.dol.gov/whd/fmla/forms. For additional information about the FMLA, including compliance assistance materials, visit www.dol.gov/whd/fmla.