FMLA Forms: WH-380-E, WH-380-F, WH-381 and WH-382 Explained
The U.S. Department of Labor’s FMLA forms page listed seven numbered optional-use forms: the certification forms WH-380-E, WH-380-F, WH-384, WH-385 and WH-385-V, and the notices WH-381 and WH-382; each form PDF printed “Expires: 8/31/2029” when we checked on November 2, 2026.
Maintained by Archie Chang · Sources checked against Department of Labor and eCFR text on November 2, 2026 · Methodology & sources
FMLA forms at a glance
| Form | Title printed on the form | What DOL says it is for | Who completes it (our summary of the section headings and instructions printed on the form) | Expires (as printed) |
|---|---|---|---|---|
| WH-380-E DOL PDF | Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act | Employee’s serious health condition, form WH-380-E - Use when a leave request is due to the medical condition of the employee. | Section I: the employee or the employer. Section II: the health care provider. (Section headings (capitalization and dashes normalized): Section I - Employer; Section II - Health Care Provider.) | 8/31/2029 |
| WH-380-F DOL PDF | Certification of Health Care Provider for Family Member’s Serious Health Condition under the Family and Medical Leave Act | Family member’s serious health condition, form WH-380-F - Use when a leave request is due to the medical condition of the employee’s family member. | Section I: the employee or the employer. Section II: the employee. Section III: the health care provider. (Section headings (capitalization and dashes normalized): Section I - Employer; Section II - Employee; Section III - Health Care Provider.) | 8/31/2029 |
| WH-381 DOL PDF | Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act | Eligibility Notice, form WH-381 – informs the employee of his or her eligibility for FMLA leave or at least one reason why the employee is not eligible. Rights and Responsibilities Notice, form WH-381 (combined with the Eligibility Notice) – informs the employee of the specific expectations and obligations associated with the FMLA leave request and the consequences of failure to meet those obligations. | The employer provides the notice to the employee. (Section headings (capitalization and dashes normalized): Section I - Notice of Eligibility; Section II - Additional Information Needed; Section III - Notice of Rights and Responsibilities.) | 8/31/2029 |
| WH-382 DOL PDF | Designation Notice under the Family and Medical Leave Act | Designation Notice, form WH-382 – informs the employee whether the FMLA leave request is approved; also informs the employee of the amount of leave that is designated and counted against the employee’s FMLA entitlement. An employer may also use this form to inform the employee that the certification is incomplete or insufficient and additional information is needed. | The employer provides the notice to the employee. (Section headings (capitalization and dashes normalized): Section I - Employer; Section II - Additional Information Needed; Section III - FMLA Leave Approved.) | 8/31/2029 |
| WH-384 DOL PDF | Certification for Military Family Leave for Qualifying Exigency under the Family and Medical Leave Act | Qualifying Exigency, form WH-384 – use when the leave request arises out of the foreign deployment of the employee’s spouse, son, daughter, or parent. | Section I: the employee or the employer. Section II: the employee. (Section headings (capitalization and dashes normalized): Section I - Employer; Section II - Employee.) | 8/31/2029 |
| WH-385 DOL PDF | Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave under the Family and Medical Leave Act | Military Caregiver Leave of a Current Servicemember, form WH-385 – use when requesting leave to care for a family member who is a current service member with a serious injury or illness. | Section I: the employee or the employer. Section II: the employee and/or the current servicemember. Section III: the health care provider. (Section headings (capitalization and dashes normalized): Section I - Employer; Section II - Employee and/or Current Servicemember; Section III - Health Care Provider.) | 8/31/2029 |
| WH-385-V DOL PDF | Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave under the Family and Medical Leave Act | Military Caregiver Leave of a Veteran, form WH-385-V – use when requesting leave to care for a family member is who [sic] a covered veteran with a serious injury or illness. | Section I: the employee or the employer. Section II: the employee and/or the veteran. Section III: the health care provider. (Section headings (capitalization and dashes normalized): Section I - Employer; Section II - Employee and/or Veteran; Section III - Health Care Provider.) | 8/31/2029 |
When we read it on November 2, 2026, the DOL forms page grouped WH-380-E, WH-380-F, WH-384, WH-385 and WH-385-V as certification forms and WH-381 and WH-382 as notice forms. It described the forms as optional-use forms:
“The Department has developed optional-use forms which can be used by employers to provide required notices to employees, and by employees to provide certification of their need for leave for an FMLA qualifying reason. These forms are electronically fillable PDFs and can be saved electronically. Alternatively, employers may use their own forms, if they provide the same basic notice information and require only the same basic certification information.”
The same page listed the FMLA poster as a notice. In 29 CFR 825.300(a)(4) (eCFR, up to date as of October 29, 2026), the prototype general notice was named WHD Publication 1420. The Department of Labor forms page did not print an expiration date for the FMLA poster or the number 1420, and we did not check the poster PDF itself.
“General Notice, the FMLA poster – satisfies the requirement that every covered employer display or post an informative general notice about the FMLA.”
“To meet the requirements of paragraph (a)(3) of this section, employers may duplicate the text of the Department's prototype notice (WHD Publication 1420) or may use another format so long as the information provided includes, at a minimum, all of the information contained in that notice.”
Certification forms: WH-380-E, WH-380-F, WH-384, WH-385 and WH-385-V
The DOL forms page counted the certification forms and described certification this way:
“There are five DOL optional-use FMLA certification forms.”
“Certification is an optional tool provided by the FMLA for employers to use to request information to support certain FMLA-qualifying reasons for leave. An employee can provide the required information contained on a certification form in any format, such as on the letterhead of the healthcare provider, or official documentation issued by the military.”
It also said where completed certification forms go:
“Please do not send any completed certification forms to the U.S. Department of Labor, Wage and Hour Division. Return completed certifications to the employee to provide to his or her employer.”
29 CFR 825.305(b) set the timing of the request and the return:
“In most cases, the employer should request that an employee furnish certification at the time the employee gives notice of the need for leave or within five business days thereafter, or, in the case of unforeseen leave, within five business days after the leave commences. The employer may request certification at some later date if the employer later has reason to question the appropriateness of the leave or its duration. The employee must provide the requested certification to the employer within 15 calendar days after the employer's request, unless it is not practicable under the particular circumstances to do so despite the employee's diligent, good faith efforts or the employer provides more than 15 calendar days to return the requested certification.”
29 CFR 825.305(c) covered a certification that is incomplete or insufficient:
“The employer must provide the employee with seven calendar days (unless not practicable under the particular circumstances despite the employee's diligent good faith efforts) to cure any such deficiency. If the deficiencies specified by the employer are not cured in the resubmitted certification, the employer may deny the taking of FMLA leave, in accordance with § 825.313.”
29 CFR 825.306 listed the information a medical certification for the employee’s own or a family member’s serious health condition may require.
Notice forms: WH-381 and WH-382
29 CFR 825.300(b) covered the eligibility notice and mentioned Form WH-381:
“When an employee requests FMLA leave, or when the employer acquires knowledge that an employee's leave may be for an FMLA-qualifying reason, the employer must notify the employee of the employee's eligibility to take FMLA leave within five business days, absent extenuating circumstances.”
“Notification of eligibility may be oral or in writing; employers may use optional Form WH-381 (Notice of Eligibility and Rights and Responsibility) to provide such notification to employees.”
29 CFR 825.300(c) covered the rights and responsibilities notice:
“Employers shall provide written notice detailing the specific expectations and obligations of the employee and explaining any consequences of a failure to meet these obligations.”
29 CFR 825.300(d) covered the designation notice, which Form WH-382 is for:
“When the employer has enough information to determine whether the leave is being taken for a FMLA-qualifying reason (e.g., after receiving a certification), the employer must notify the employee whether the leave will be designated and will be counted as FMLA leave within five business days absent extenuating circumstances.”
Expiration dates and employer versions
Each form PDF printed an expiration date of 8/31/2029 and OMB Control Number 1235-0003. The DOL forms page answered the expiration question:
“Yes. The content of the information contained within the optional-use DOL form is still applicable, regardless of the expiration date. The expiration date on the DOL forms is related to the collection of information as required by the Office of Management and Budget (OMB), and not relevant to the content of the required information.”
It also answered whether an employer can change the forms:
“Your employer may use the WHD prototype forms or create their own version of the forms containing the same basic information. However, an employer that requests a medical certification may request only information that relates to the serious health condition for which the current need for leave exists, and no information may be required beyond that specified in the FMLA regulations.”
FMLA eligibility (partial summary)
This section is partial. It quotes the three eligibility tests in 29 CFR 825.110(a), the Fact Sheet #28 summary and the coverage paragraphs named below. It does not cover key employees, job restoration, intermittent or reduced schedule leave, the break in service rules or the hours of service rules in 29 CFR 825.110, state family-leave laws, the rules of any other agency, employees who work outside the U.S., or federal civilian employees.
“Employees are eligible if they work for a covered employer for at least 12 months, have at least 1,250 hours of service with the employer during the 12 months before their FMLA leave starts, and work at a location where the employer has at least 50 employees within 75 miles.”
“An eligible employee is an employee of a covered employer who:
Has been employed by the employer for at least 12 months, and
Has been employed for at least 1,250 hours of service during the 12-month period immediately preceding the commencement of the leave (see § 825.801 for special hours of service requirements for airline flight crew employees), and
Is employed at a worksite where 50 or more employees are employed by the employer within 75 miles of that worksite.”
Fact Sheet #28 summarized which employers were covered, and the next quotation is that Fact Sheet’s summary of covered employers, followed by the sentence its Enforcement section gave about federal employees:
“Covered employers under the FMLA include:
Private-sector employers who employ 50 or more employees in 20 or more workweeks in either the current calendar year or previous calendar year,
Public agencies (including Federal, State, and local government employers, regardless of the number of employees), and
Local educational agencies (including public school boards, public elementary and secondary schools, and private elementary and secondary schools, regardless of the number of employees).”
“Most Federal and certain congressional employees are also covered by the law but are subject to the jurisdiction of the U.S. Office of Personnel Management or Congress.”
29 CFR 825.104(a) gave the 50-employee test in its first sentence; the rest of 29 CFR 825.104 (successors in interest, public agencies) is not summarized here.
“An employer covered by FMLA is any person engaged in commerce or in any industry or activity affecting commerce, who employs 50 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding calendar year.”
29 CFR 825.109(a) addressed federal agency coverage:
“Most employees of the government of the United States, if they are covered by the FMLA, are covered under Title II of the FMLA (incorporated in Title V, Chapter 63, Subchapter 5 of the United States Code) which is administered by the U.S. Office of Personnel Management (OPM). OPM has separate regulations at 5 CFR Part 630, Subpart L.”
Most employees of the U.S. government who are covered are under Title II of the FMLA, which OPM administers (29 CFR 825.109(a)). This page does not cover federal civilian employees and states no eligibility rule for them; we did not read OPM’s rules, so the page does not say whether they differ from the tests quoted above.
How much FMLA leave
Fact Sheet #28 stated the amounts:
“Eligible employees may take:
Up to 12 workweeks of leave in a 12-month period for any FMLA leave reason except military caregiver leave, and
Up to 26 workweeks of military caregiver leave during a single 12-month period.”
29 CFR 825.200(a) listed the reasons the 12-workweek limit applies to:
“Except in the case of leave to care for a covered servicemember with a serious injury or illness, an eligible employee's FMLA leave entitlement is limited to a total of 12 workweeks of leave during any 12-month period for any one, or more, of the following reasons:
The birth of the employee's son or daughter, and to care for the newborn child;
The placement with the employee of a son or daughter for adoption or foster care, and to care for the newly placed child;
To care for the employee's spouse, son, daughter, or parent with a serious health condition;
Because of a serious health condition that makes the employee unable to perform one or more of the essential functions of his or her job; and,
Because of any qualifying exigency arising out of the fact that the employee's spouse, son, daughter, or parent is a military member on covered active duty status (or has been notified of an impending call or order to covered active duty).”
The four methods below apply to the 12-workweek entitlement in paragraph (a), and 29 CFR 825.200(b) let the employer choose among them:
“An employer is permitted to choose any one of the following methods for determining the 12-month period in which the 12 weeks of leave entitlement described in paragraph (a) of this section occurs:
The calendar year;
Any fixed 12-month leave year, such as a fiscal year, a year required by State law, or a year starting on an employee's anniversary date;
The 12-month period measured forward from the date any employee's first FMLA leave under paragraph (a) begins; or,
A "rolling" 12-month period measured backward from the date an employee uses any FMLA leave as described in paragraph (a).”
For military caregiver leave, 29 CFR 825.200(f) set a different single 12-month period:
“An eligible employee's FMLA leave entitlement is limited to a total of 26 workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness. An employer shall determine the single 12-month period in which the 26-weeks-of-leave-entitlement described in this paragraph occurs using the 12-month period measured forward from the date an employee's first FMLA leave to care for the covered servicemember begins.”
This page does not quote 29 CFR 825.200(c), (d) or (e), which cover how each method works, uniform application and the notice for a change, and what applies if the employer does not choose, or paragraphs (g) and (h), which cover combined leave in the caregiver year and holidays.
Frequently asked questions
Which FMLA form does a health care provider fill out?
The Department of Labor’s FMLA forms page said when we read it on November 2, 2026 that there are five optional-use FMLA certification forms: WH-380-E (the employee’s own serious health condition), WH-380-F (a family member’s serious health condition), WH-384 (qualifying exigency), WH-385 (a current servicemember) and WH-385-V (a veteran). When we checked on November 2, 2026, the PDFs printed a health care provider section on four of them: Section II of WH-380-E and Section III of WH-380-F, WH-385 and WH-385-V. The WH-384 PDF had Sections I and II only, and its Section II was for the employee. The forms page also said employers may use their own forms if they provide the same basic notice information and require only the same basic certification information.
What is the difference between Form WH-381 and Form WH-382?
WH-381 is the Notice of Eligibility & Rights and Responsibilities: the U.S. Department of Labor (DOL) forms page said the eligibility notice informs the employee of his or her eligibility for FMLA leave or at least one reason why the employee is not eligible. WH-382 is the Designation Notice, which the forms page said informs the employee whether the FMLA leave request is approved and the amount of leave that is designated and counted against the employee’s FMLA entitlement. In 29 CFR 825.300(b)(1) and (d)(1) (eCFR, up to date as of October 29, 2026), the eligibility notice and the designation notice were each due within five business days, absent extenuating circumstances.
How long does an employee have to return an FMLA certification?
In 29 CFR 825.305(b) (eCFR, up to date as of October 29, 2026), the employee had to provide the requested certification to the employer within 15 calendar days after the employer’s request, unless it is not practicable under the particular circumstances to do so despite the employee’s diligent, good faith efforts or the employer provides more than 15 calendar days. The WH-380-E and WH-380-F PDFs printed that the employer must give the employee at least 15 calendar days to provide the certification.
Who is eligible for FMLA leave?
Fact Sheet #28 said employees are eligible if they work for a covered employer for at least 12 months, have at least 1,250 hours of service with the employer during the 12 months before their FMLA leave starts, and work at a location where the employer has at least 50 employees within 75 miles. Most employees of the U.S. government, if they are covered by the FMLA, are covered under Title II of the FMLA, which is administered by the U.S. Office of Personnel Management (OPM) (29 CFR 825.109(a)), and FedRateCalc’s FMLA forms page does not cover them. 29 CFR 825.110 has further rules, such as those for a break in service, that FedRateCalc’s FMLA forms page does not summarize.
How much FMLA leave can an eligible employee take?
Fact Sheet #28 said eligible employees may take up to 12 workweeks of leave in a 12-month period for any FMLA leave reason except military caregiver leave, and up to 26 workweeks of military caregiver leave during a single 12-month period. For the 12-workweek entitlement, 29 CFR 825.200(b) permitted the employer to choose the calendar year, a fixed 12-month leave year, a 12-month period measured forward from an employee’s first FMLA leave, or a rolling 12-month period measured backward. For military caregiver leave, 29 CFR 825.200(f) said the single 12-month period is measured forward from the date an employee’s first FMLA leave to care for the covered servicemember begins.
Do the FMLA forms expire, and can a form past its expiration date still be used?
Each of the seven form PDFs printed “Expires: 8/31/2029” when we checked on November 2, 2026. The U.S. Department of Labor (DOL) forms page said the content of the optional-use DOL form is still applicable regardless of the expiration date, and that the expiration date is related to the collection of information required by the Office of Management and Budget.
Are completed FMLA forms sent to the Department of Labor?
No. The U.S. Department of Labor (DOL) forms page said not to send completed certifications or forms to the Wage and Hour Division. The employer provides the required notices to the employee seeking leave, and completed certification forms are given to the employee to provide to the employer.
Related pages
Sources (checked November 2, 2026): U.S. DOL Wage and Hour Division: FMLA Forms · DOL Fact Sheet #28: The Family and Medical Leave Act · 29 CFR part 825 in the eCFR (up to date as of October 29, 2026) · Form WH-380-E (DOL PDF) · Form WH-380-F (DOL PDF) · Form WH-381 (DOL PDF) · Form WH-382 (DOL PDF) · Form WH-384 (DOL PDF) · Form WH-385 (DOL PDF) · Form WH-385-V (DOL PDF)