Insurance

Family Medical Leave Forms

(From the Department of Labor – Wage & Hour Division website)

We suggest using the federal forms for your family leave application for two reasons:

1. These respective forms are more recognizable to health care providers as they are used by most employers to ensure appropriate compliance with the laws governing family leave administration.
2. These forms are constructed by the Department of Labor. Therefore, use of these forms ensures that all necessary information and only the necessary information is provided by the employee to the employer.

Choose application form that applies to your particular situation:

• Certification of Health Care Provider for Employee’s Serious Health Condition – Self (Form WH-380-E)
• Certification of Health Care Provider for a Family Member’s Serious Health Condition - Other Than Self (Form WH-380-F)
• Certification of Qualifying Exigency for Military Family Leave (form WH-384)
  What is this form?

• Certification for Serious Injury or Illness of Covered Servicemember - for Military Caregiver Family Leave (Form WH-385)
  What is this form?

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Latest FMLA News

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FMLA Fairness Signed into Law

December 22, 2009 - AFA Article

Dec 22 - President Obama signed into law the Airline Flight Crew Technical Corrections Act, amending the Family and Medical Leave Act of 1993 (FMLA) to include our unique work schedules to allow us to qualify for the benefits in an equivalent manner as the requirements for every other working American.

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