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Family and Medical Leave Act (FMLA) Forms


The Family and Medical Leave Act (FMLA) is a law that ensures that employees have access to up to 12 weeks of unpaid, job-protected leave per year for qualified medical and family-related reasons. Up to 26 weeks of leave are available to employees caring for a servicemember with an illness or serious injury. As a result of the coronavirus outbreak and the Families First Coronavirus Response Act (FFCRA), several FMLA benefits have been expanded. However, these expanded benefits are set to expire come 2021.

What Is the Family and Medical Leave Act (FMLA)?

The Family and Medical Leave Act was passed in 1993. It provides employees with annual access to extended periods of leave for up to 12 weeks for reasons pertaining to qualified medical and family reasons. These reasons include:

  • Birth and care of a newborn child within one year of birth
  • Care for a child placed into the employee’s family through adoption or foster care
  • Serious health condition that causes the employee to be unable to perform job functions
  • Care of spouse, parent or child with a serious health condition
  • Any qualified urgency due to the employee’s spouse, child or parent is a military member on covered active duty

The FMLA also offers up to 26 weeks of covered leave during a year period if they are caring for a servicemember with a serious illness or injury. This servicemember must be a spouse, child or parent of the employee. This is referred to as military caregiver leave.

The FFCRA expanded FMLA coverage in two ways. The first is through the Emergency Family and Medical Leave Expansion Act (EFMLEA), which enhances the benefits offered through the FMLA. More specifically, it requires that certain employers offer up to 10 weeks of paid leave and two weeks of unpaid leave if an employee is caring for their child because of a coronavirus-related school or child care provider closure. The second perk comes from the Emergency Paid Sick Leave Act (EPSLA), which grants qualified employees up to two weeks of paid sick leave. Both are set to expire on December 31, 2020.

All agencies and schools are subject to the FMLA, including the changes that were part of the FFCRA. Benefits apply to employees who have been employed at their job for at least 30 days. Businesses with more than 500 employees are not eligible under the FMLA.

Breaking Down the Different FMLA Forms

FMLA Forms

There are seven separate FMLA forms, all of which serve a specific purpose. While each form requires slightly different details, they all ask for basic information. That can cover the employee and employer’s names, positions, amount of required leave and contact information. These forms are relatively easy to fill out.

Here’s an overview of each:

WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition

Form WH-380-E is for when an employee needs to take leave due to a personal health issue, not an external issue. You’ll need a healthcare provider to sign off on the form, along with a list of the medical facts surrounding the health condition.

WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition

If an employee needs to take extended leave to care for a covered family member with a serious health condition, Form WH-380-F is what should be used. Like WH-380-E, you’ll need the help of a healthcare provider to fill out this form, along with a breakdown of how much care the family member will need.

WH-381 Notice of Eligibility and Rights & Responsibilities

Form WH-381 is unique in that it is filled out entirely by an employer whose employee has requested extended leave. The form’s use is to inform the employee of their eligibility for leave under the FLMA.

WH-382 Designation Notice

Form WH-382 is reserved for use by the government and will be sent to employees and employers when a request for leave under the FLMA has been made. It notifies the applicant of the government’s decision as to whether the request for leave has been granted. If the application has not been accepted, it will detail what the applicant needs to do to be approved.

WH-384 Certification of Qualifying Exigency for Military Family Leave

Form WH-384 is for employees who are requesting leave due to the fact that a family member is participating in military duties. This may include leave to meet with a third-party to arrange care.

WH-385 Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave

Form WH-385 is for employees who need to take leave to care for a family member who is in the military and has a serious injury or illness. This is similar to Form WH-380-F, in that it covers leave for the purpose of taking care of family members. To submit the form, you’ll need the help of a U.S. Department of Defense official or a qualified healthcare provider.

WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

When an employee needs to take an extended leave to care for a military veteran, fill out Form WH-385-V. This is used in situations that are similar to what Form WH-385 is used for. You’ll again need the help of a U.S. Department of Defense official or a qualified healthcare provider to fill out this form.

Bottom Line

FMLA Forms

The FLMA is a great resource for employees who are in need of extensive time off from work. The expanded provisions under the FFCRA have helped many Americans get the help they need when it comes to caring for themselves and loved ones in the wake of the coronavirus pandemic. Make sure you understand which of the various FMLA forms you’ll have to fill out, and who’s help you’ll need. Also, make sure you understand what parts of the FMLA are expiring on December 31, 2020. That way you can be ready for whatever comes your way during the process.

Tips for Managing Your Money During the Coronavirus Pandemic

  • The current state of the U.S. economy can make planning your financial future difficult. If you’d like help putting together a financial plan, speak with a financial advisor. SmartAsset’s free tool can match you with financial advisors in your area in just five minutes. If you’re ready to get connected to a local advisor, get started now.
  • If you find yourself unemployed due to the coronavirus outbreak, don’t panic. There are a number of unemployment provisions in the CARES Act that offer help. These include $600 more in weekly unemployment insurance and 13 extra weeks of unemployment eligibility.

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