FMLA: Forms | U.S. Department of Labor
Summary: Form WH-381 is an optional U.S. Department of Labor form used by employers to notify employees of their eligibility for FMLA leave and outline their rights and responsibilities.
Form WH-381, 'Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act,' is a standard document provided by the U.S. Department of Labor Wage and Hour Division. It is designed to help employers comply with 29 C.F.R. §§ 825.300(b) and (c) by informing employees of their FMLA eligibility status within five business days of a leave request. The form covers eligibility criteria, requests for additional certification, FMLA leave entitlements, substitution of paid leave, maintenance of health benefits, and return-to-work requirements.
Document outline
1. Section I: Notice of Eligibility (Criteria for FMLA leave) 2. Section II: Additional Information Needed (Certification requirements) 3. Section III: Notice of Rights and Responsibilities 4. Part A: FMLA Leave Entitlement (Calculation of leave periods) 5. Part B: Substitution of Paid Leave 6. Part C: Maintain Health Benefits 7. Part D: Other Employee Benefits 8. Part E: Return-to-Work Requirements 9. Part F: Other Requirements While on FMLA Leave 10. Paperwork Reduction Act Notice