Revised FMLA Forms 

Recently, the U.S. Department of Labor (DOL) revised Family and Medical Leave Act (FMLA) forms. These revisions require more detailed information in certain notices and medical certifications. 

The forms changed include: 

• WH-381, notice of eligibility and rights and responsibilities 
• WH-382, designation notice 
• WH-380-E, medical certification of an employee’s serious health condition 
• WH-380-F, medical certification of a family member’s serious health condition

Notice of Eligibility and Rights and Responsibilities 

Significant changes were made to the notice of eligibility and rights and responsibilities forms. The forms now have seven sections related to an employee’s FMLA leave and return to work plans. 

The DOL also aligned this notice with leave regulations, including employers’ ability to indicate:   

• If and how short an employee falls below the required 1,250 hours of service within 12 months before FMLA leave 
• How the FMLA leave impacts employee benefits outside of health insurance 
•  If FMLA leave will be available with Workers’ Compensation benefits, disability insurance coverage, or leave required by state law 

Designation Notice 

A noteworthy adjustment to this form is the outline of steps an employee can take to amend an incomplete/insufficient certification. 

Medical Certifications   

The revised medical certification form for an employee’s/family members’ serious health condition now requires the medical provider to estimate the timing of future treatments. 

RBN as a Resource 

RBN is a resource for you and your company for up-to-date compliance information, including changes to required forms and certificates.