FMLA Form Wh-382

Page 1 of 2 Form WH-382, Revised June 2020. DO NOT SEND TO THE DEPARTMENT OF LABOR. OMB Control Number: 1235-0003 . PROVIDE TO EMPLOYEE. Expires: 6/30/2023 . Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA -protected and the employer must inform the employee of the amount of leave that will be counted against the …

While use of this form by employers is optional, a fully completed Form WH-382 provides an easy method of providing employees with the written information required by 29 C.F.R. §§ 825.300(c), 825.301, and 825.305(c). . To: _____ Date: _____ We have reviewed your request for leave under the FMLA and any supporting documentation that you have provided. We received your most …

For FMLA purposes, a “serious health condition” means an illness, injury, impairment, or physical or mental condition that … Page 1 of 4 Form WH-380-E, Revised June 2020 . U.S. Department of Labor Wage and Hour Division Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act. DO NOT SEND COMPLETED FORM TO THE …

Designation Notice WH-382 exp 063023.pdf Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA-protected and the employer must inform the employee of the amount of leave that will be counted against the employee’s FMLA leave entitlement.

WH-382 : FMLA Designation Notice. WH-382 Form & Instruction; WH-384 : FMLA Certification of Qualifying Exigency For Military Family Leave. WH-384 Form & Instruction; WH-385: FMLA Certification for Serious Injury or Illness of Covered Servicemember — for Military Family Leave. WH-385 Form & Instruction ; WH-385V: FMLA Certification for Serious Injury or Illness of a …

After the completed Request for Family/Medical Leave under the FMLA form has been received and reviewed, complete the Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act) WH-381 form and the Designation Notice (Family and Medical Leave Act) WH-382 form, and give to the employee via hand delivery or certified mail …

FMLA. Once we obtain the additional information requested, we will inform you within 5 business days if your leave will or will not be designated as FMLA leave and count towards the amount of FMLA leave you have available. Failure to provide the additional information as requested may result in a denial of your FMLA leave request.

Form WH-382 Jan 2009
Benefits Version 10/1/18 . Return completed forms to UF Benefits by fax (352) 392-5166. FMLA DESIGNATION NOTICE . As explained in the Notice of Eligibility, you meet the eligibility requirements for taking FMLA leave and still have FMLA leave available in the applicable 12-month period. However, in order for us to determine whether your absence …