FMLA: Forms - U.S. Department of Labor
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. Help for health care providers – This flier guides healthcare providers through FMLA rules concerning medical certifications.
The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. 29 U.S.C. §§ 2613, 2614(c)(3); 29 C.F.R. § 825.305.
Family and Medical Leave Act (FMLA) 12-Week Entitlement
The current FMLA Medical Certification Form for Employee’s Serious Health Condition - WH-380-E permits, but does not require, that the healthcare provider include a diagnosis. Note that the FMLA regulations do not specify to whom the medical certification must be provided, but only indicate that it must be provided to the agency.
Leave Administration - U.S. Office of Personnel Management
OPM's regulations on the establishment of work schedules can be found in 5 CFR part 630, Absence and Leave. This index highlights the laws, regulations, and other references relating to Federal leave programs and policies. The index is a valuable resource for researching major leave subject-matter areas.
Employees’s Serious Health Condition . under the Family and Medical Leave Act WH-380-E. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR. OMB Control Number: 1235-0003 RETURN TO THE PATIENT. Expires: 6/30/2026.
The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. 29 U.S.C. §§ 2613, 2614(c)(3); 29 C.F.R. § 825.305.
INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued …
FMLA WH-380-F Certification of Health Care Provider for
Family and Medical Leave Act: WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition. For more information visit Qcera Homepage or LeaveSource. FMLA Forms Instructions for WH-380F. View Fullscreen
Forms - U.S. Department of Labor
Revised WH-347 Form & Instruction Applicable to Contracts Entered into Pursuant to Invitations for Bids Issued or Negotiations Concluded On or After January 18, 2009. IMPORTANT! This webpage contains important information about your workplace rights and responsibilities provided by the Wage and Hour Division.
Form WH-380-F Revised May 2015 PART B: AMOUNT OF CARE NEEDED: When answering these questions, keep in mind that your patient’s need for care by the employee seeking leave may include assistance with basic medical, hygienic, nutritional, safety or