Review this notice carefully — it tells you how much FMLA leave you have remaining

If your employer designates leave retroactively, they must notify you within 5 business days

Your employer must tell you if a fitness-for-duty certification is required before you return to work

Employment / FMLAeasy

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.

Form Details

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Where to Submit This Form

📬

Employer provides this designation notice to the employee

This form is issued BY the employer TO the employee after reviewing medical certification.

Filing Deadline

Employer must provide within 5 business days of having enough information to determine if leave qualifies as FMLA.

Processing Time

Immediate — this IS the employer's designation decision.

What Happens Next

If designated as FMLA leave, your leave counts against your 12-week entitlement. The notice specifies whether leave is FMLA-qualifying, the amount of leave counted, and whether a fitness-for-duty certification is required to return.

Tips for This Form

✓ Review this notice carefully — it tells you how much FMLA leave you have remaining
✓ If your employer designates leave retroactively, they must notify you within 5 business days
✓ Your employer must tell you if a fitness-for-duty certification is required before you return to work
✓ Reference: https://www.dol.gov/agencies/whd/fmla/forms

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 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.

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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