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DOL Updates Model FMLA Forms

Posted 06.02.15

The Family and Medical Leave Act of 1993 (FMLA) gives an eligible employee the right to take unpaid, job-protected leave in certain situations, including the birth, adoption or foster care placement of a child, his or her own or a family member’s serious health condition and a family member’s military service.

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

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).

The links to the updated model forms are below. In addition, employers should also confirm that they are using the most updated FMLA poster from February 2013.

  • 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).

Contact your NEEBCo representative with any additional questions you may have on FMLA.

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