SECTION I EMPLOYER DOL
https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-F.pdf
Please complete and sign Section II before providing this form to your family member or your family member’s health care provider. The FMLA allows an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to the serious health condition of your family member.
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Family And Medical Leave Act Employee Serious Health
https://www.hrm.oa.pa.gov/Leave/forms/Documents/FMLA/cert-employee-serious-health-condition.pdf
support a request for an absence that may qualify as FMLA leave due to your own serious health condition. Your response is required to obtain or retain the benefit of FMLA protections. Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request. If this is a request for leave to care for a family member or next of kin, do not use this …
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Family Medical Leave Employer Instructions And Forms
https://download.paychex.com/pas_pbs/formfiles/pbs_fmla.pdf
After the completed Request for Family/Medical Leave under the FMLAform 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.
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Certification Of Health Care Provider For Family Member S
https://www.yccd.edu/wp-content/uploads/2020/07/FMLA-form-DOL.pdf
may require an employee seeking FMLA protections because of a need for leave to care for a covered family member with a serious health condition to submit a medical certification issued by the health care provider of the covered family member. Please complete Section I before giving this form to your employee. Your response is voluntary. While …
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Certification Of Health Care Provider For U S Department
https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-E.pdf
While use of this form is optional, this form asks the health care provider for the information necessary for a complete and sufficient medical certification, which is set out at 29 C.F.R . § 825.306. You may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Additionally, you . may not . request a …
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Forms UC Davis Human Resources
https://hr.ucdavis.edu/forms
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Fact Sheet 28G Certification Of A Serious Health
https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/whdfs28g.pdf
Certification forms – The FMLA does not require the use of any specific certification form. The Department has developed optional forms that can be used for leave for an employee’s own serious health condition (WH-380-E) or to care for a family member’s serious health condition (WH-380-F), or the employer may use its own forms. If the employer chooses to use its own …
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