Kyle Von Ruden September 25, 2018 8 min read

Legislative Brief: DOL Updates Model FMLA Forms





The Department of Labor (DOL) recently released updated model forms to help employers administer employee leaves under the Family and Medical Leave Act (FMLA). The DOL’s model FMLA forms contain an expiration date in the upper right corner. The expiration date relates to a regulatory approval process; it does not relate to the forms’ actual content. Every three years, the DOL must submit its model FMLA forms to the federal Office of Management and Budget (OMB) for approval for continued use.

The DOL’s model FMLA forms expired earlier this year, on May 31, 2018. The DOL extended the forms’ expiration date on a month-to-month basis while it waited for the OMB approval’s to release updated forms. After receiving the OMB’s approval, the DOL released the updated model forms, which contain a new expiration date—Aug. 31, 2021. 


Employers that use the model FMLA forms should start using the DOL’s updated models as soon as possible. Although no substantive changes were made to the updated FMLA forms, they contain a new expiration date. The updated model FMLA forms are available on the DOL’s FMLA webpage.  


The FMLA gives an eligible employee the right to take unpaid, job-protected leave in certain situations, including the birth, adoption or foster care placement of a child, his or her own or a family member’s serious health condition, and a family member’s military service.

To administer FMLA leaves, employers must provide certain notices to employees, such as a notice designating whether a requested leave will qualify as FMLA leave. Employers may also require that employees provide certifications to substantiate their eligibility for certain types of FMLA leave.

The DOL has provided model notices and certifications to help employers administer FMLA leaves. The DOL’s model FMLA forms are optional; employers may decide to customize the DOL’s model forms or create their own FMLA forms. The model FMLA forms are available on the DOL’s FMLA webpage.

The DOL’s model FMLA forms include:

A notice of FMLA eligibility and rights and responsibilities (Form WH-381);

An FMLA designation notice (Form WH-382);

A health care provider’s certification form for an employee’s serious health condition (WH-380-E);

A health care provider’s certification form for a family member’s serious health condition (WH-380-F);

A certification of qualifying exigency for military family leave (WH-384);

A certification for serious injury or illness of a covered service member (WH-385); and

A certification for serious injury or illness of a veteran for military caregiver leave (WH-385-V).


The DOL recently released new model FMLA forms that have an expiration date of Aug. 31, 2021. This expiration date is not associated with the FMLA’s requirements or the content of the model forms. Rather, it is associated with a regulatory approval process that requires the DOL to submit its model FMLA forms to the OMB for approval for continued use every three years.

The prior model FMLA forms had an expiration date of May 31, 2018, in the upper right corner. In April 2018, the DOL requested that the OMB reauthorize the model FMLA forms for another three-year period, until 2021, without proposing any substantive changes to the forms. The DOL released its updated model FMLA forms after the OMB approved this request.

If you have questions on this legislative brief, please contact a member of the Hausmann-Johnson Insurance Benefits team.


Kyle Von Ruden

Kyle has been with Hausmann Group since 2008 and became an owner in 2016. He primarily consults employer groups on developing and/or maintaining their high level of benefits while controlling very important costs. Kyle works with various size employers, speaks publicly on alternative benefit strategies including HRA, HSA, FSA’s and proactively keeps his clients educated on the ever-changing Health Care Reform Requirements. He understands that employees are a business’s greatest asset and having a high level benefits program will undoubtedly help with recruitment and retention. He has previous experience as a Property Casualty Agent with Group, and a Commercial Lender in the banking industry. Kyle graduated from the University of Wisconsin-Madison with a BS in Economics. A fun fact - Kyle was a member of the UW–Madison’s Men’s NCAA Division 1 National Champion Soccer team in 1995. In addition to actively participating in two SHRM chapters, he also serves on the Board of Directors with 4 local community based not-for-profit organizations (President / Middleton Chamber of Commerce 2017, Executive Director / Pet Care & Assistance Fund, Treasurer / Middleton United Soccer Club and Board Member of Work Plus, Inc.)