Family Medical Leave Act

FMLA Forms

FMLA Notice - (post with Labor Law poster; copy to new hires-include in Payroll Sign-up)
Family Medical Leave Policy (3-0708) - (to be given to employee with a copy of the rights/responsibilities document (WH381) and the appropriate certification document (WH380E, WH380F, WH384, WH385)
WH381-Notice of Eligibility and Rights and Responsibilities form - (give to the employee when notice is received of the need for the leave; also provide the appropriate certification document WH380E, WH380F, WH384, WH385 and a copy of the FMLA policy)
WH380E-Certification of Health Care Provider form for Employee’s Serious Health Condition - (use for employee only leave; provide a copy of FMLA policy & form WH381)
WH380F-Certification of Health Care Provider form for Family Member’s Serious Health Condition - (use for family member only; provide a copy of FMLA policy & form WH381)
WH384-Certification of Qualifying Exigency for Military Family Leave - (to be used for exigency leave for a qualifying family member; exigency is defined as short-term deployment, military events/activities; childcare/school activities or financial/legal arrangements-non routine, counseling, rest & recuperation, post-deployment activities, or other additional activities; provide a copy of FMLA policy & form WH381)
WH385-Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - (use for care of a family member who became ill or injured while serving in the military; provide a copy of FMLA policy & form WH381)
WH385V- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave - (to be used for an employee seeking military caregiver leave under the FMLA leave due to a serious injury or illness of a covered veteran; provide a copy of the FMLA policy & form WH 381)
WH382-Designation Notice - (give to inform employee that FMLA has been approved & paid leave is/is not being used, leave does not apply to FMLA, FMLA leave has been exhausted, or FMLA leave is not approved; used after medical or supporting documentation has been received from the employee)

FMLA Letter Samples

Initial Letter - Employee Illness Initial Letter - Family Member
Initial Letter - Dept. Initiating FMLA Initial Letter - FMLA Designation & Workers' Comp
Approval Letter - Intermittent Approval/Designation Approval Letter - Block Leave Designation
Letter to Admin Asst (when FMLA is approved) Letter - Employee Not Returning Certification
Letter - FMLA Exhaustion Initial Letter - Emp Illness (mail version)
Recertification Letter Sample Parental (Non-Birth Mother) Letter Sample
Denial Letter - Sample Approval Letter - Maternity Leave/Designation

FMLA Tools

FMLA Why Centralize FMLA Supervisor FAQ’s
FMLA FAQ’s How to Approve or Deny the Request for FMLA Leave
FMLA Overview FMLA Steps – Emp Fam Member
FMLA Tracking Form FMLA Steps – Employee Illness
FMLA Leave of Absence Form FMLA Declaration of Relation Form
FMLA - Slideshow Presentation FMLA Measurement Tool
HIPAA Privacy Regulations FMLA Training Video
FMLA Minute FMLA for Care of Servicemember: FAQ
FMLA for Qualifying Exigency Leave: FAQ  

Important Links

ComPsych Link:
Department of Labor FMLA Poster:
Department of Labor FMLA Test:
Department of Labor Guide Link:  Dept of Labor (DOL) Employee Information Guide
DOL Qualifying Reasons Fact Sheet:
Long-Term Disability Insurance Procedures for Employees (pdf)
Long-Term Disability Benefit