Model FMLA Forms from DOL Expire in 2018 | Clarus Benefits Group

Overview

The Department of Labor (DOL) maintains model forms to help employers meet their notification obligations under the Family and Medical Leave Act (FMLA). Employers are not required to use the DOL’s model forms; they can customize the model forms or create their own FMLA forms.

Every three years, the DOL must submit its model FMLA forms to the federal Office of Management and Budget (OMB) for approval for continued use. The OMB’s approval for the current FMLA forms expires in 2018. This expiration date is included on the model forms in the upper right corner. The DOL has requested that the OMB reauthorize the model FMLA forms for another three-year period, until 2021, without proposing any substantive changes to the forms. 


To administer FMLA leaves, employers must provide certain notices to employees. Employers may also require that employees provide certifications to substantiate their eligibility for certain types of FMLA leave.

The DOL has provided model notices and certifications to help employers administer FMLA leaves. The DOL’s model FMLA forms are optional; employers may customize the DOL’s model forms or create their own FMLA forms.

The DOL's model forms Include:

  • A notice of FMLA eligibility and rights and responsibilities (Form WH-381);
  • An FMLA designation notice (Form WH-382);
  • A health care provider’s certification form for an employee’s serious health condition (WH-380-E);
  • A health care provider’s certification form for a family member’s serious health condition (WH-380-F);
  • A certification of qualifying exigency for military family leave (WH-384);
  • A certification for serious injury or illness of a covered service member (WH-385); and
  • A certification for serious injury or illness of a veteran for military caregiver leave
    (WH-385-V).

Next Steps

You will want to monitor the DOL's FMLA webpage for the updated forms. The current forms have been granted a month-to-month extension, pending the approval by the OMB for a 3 year extension of the forms. The current forms have an expiration date in the upper right hand corner of June 30, 2018. The DOL will update these forms monthly while awaiting approval from OMB and once approval is received the forms will be updated to reflect the 2021 expiration date.