DOL UPDATES MODEL FMLA FORMS

April 30, 2015

The DOL’s model FMLA forms expired on Feb. 28, 2015. After a few months of extending the expiration date on its model FMLA forms, the DOL recently issued updated model forms. The updated model FMLA forms include the following changes:

  • The updated model forms have an expiration date of May 31, 2018; and

  • The model certification forms that request medical information have been updated to include information on the Genetic Information Nondiscrimination Act (GINA)

Action Steps: Employers that use the model FMLA forms should start using the DOL’s updated models as soon as possible. Employers that have developed their own forms should review the DOL’s updated models to make sure their own medical certification forms contain GINA information. Employers should also confirm that they are using the most updated FMLA poster from February 2013. 

 

Updated Model FMLA Forms

  • Certification of Health Care Provider for Employee’s Serious Health Condition (Form WH-380-E);

  • Certification of Health Care Provider for Family Member’s Serious Health Condition (Form WH-380-F);

  • Notice of Eligibility and Rights & Responsibilities (Form WH-381);

  • Designation Notice (Form WH-382)

  • Certification of Qualifying Exigency for Military Family Leave (Form WH-384);

  • Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (Form WH-385); and

  • Certification for Serious Injury or Illness of a Veteran for Military Family Leave (Form WH-385-V).

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