If your employer fails to provide this notice, they may be unable to deny your FMLA request later

You are eligible if you worked 1,250+ hours in the past 12 months and your employer has 50+ employees within 75 miles

Keep a copy for your records — it documents your FMLA eligibility determination

Employment / FMLAeasy

FMLA Notice of Eligibility and Rights & Responsibilities

WH-381 · U.S. Department of Labor

Notice of Eligibility and Rights & Responsibilities. Employer must provide within 5 business days of FMLA leave request, stating whether employee is eligible.

Form Details

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Where to Submit This Form

📬

Employer provides this to the employee

This form is issued BY the employer TO the employee. It is not submitted by the employee.

Filing Deadline

Employer must provide this within 5 business days of learning of the employee's need for FMLA leave.

Processing Time

Employer must notify you of your eligibility within 5 business days.

What Happens Next

If eligible, your employer will also provide a Rights & Responsibilities notice. You may be asked to provide medical certification (WH-380-E or WH-380-F) within 15 days.

Tips for This Form

✓ If your employer fails to provide this notice, they may be unable to deny your FMLA request later
✓ You are eligible if you worked 1,250+ hours in the past 12 months and your employer has 50+ employees within 75 miles
✓ Keep a copy for your records — it documents your FMLA eligibility determination
✓ DOL FMLA fact sheet: https://www.dol.gov/agencies/whd/fmla

More Employment / FMLA Forms

FMLA Certification - Employee's Serious Health Condition

WH-380-E · U.S. Department of Labor

Certification of Health Care Provider for Employee's Serious Health Condition. Medical certification for FMLA leave for the employee's own condition.

FMLA Certification - Family Member's Serious Health Condition

WH-380-F · U.S. Department of Labor

Certification of Health Care Provider for Family Member's Serious Health Condition. Medical certification when employee needs leave to care for a family member.

FMLA Designation Notice

WH-382 · U.S. Department of Labor

Designation Notice. Employer designates leave as FMLA-qualifying or denies it. Must be provided within 5 business days of receiving sufficient certification.

FMLA Certification - Qualifying Exigency (Military)

WH-384 · U.S. Department of Labor

Certification of Qualifying Exigency for Military Family Leave. For leave due to a covered family member's active duty or call to active duty.

FMLA Certification - Serious Injury/Illness of Servicemember

WH-385 · U.S. Department of Labor

Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (current servicemember).

FMLA Certification - Serious Injury/Illness of Veteran

WH-385-V · U.S. Department of Labor

Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave.

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