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FMLA: Forms | U.S. Department of Labor

Official U.S. Department of Labor Form WH-382, Designation Notice under the Family and Medical Leave Act (FMLA).

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FMLA: Forms | U.S. Department of Labor

Summary: Form WH-382 is an optional-use Designation Notice provided by the U.S. Department of Labor for employers to inform employees whether their leave request is approved as FMLA-protected.

The WH-382 Designation Notice is a standard form used by employers to comply with FMLA notification requirements under 29 C.F.R. ยงยง 825.300(d), 825.301, and 825.305(c). It allows employers to formally notify employees if their leave request is approved, denied, or if additional information (such as a medical certification) is required. The form also outlines how much leave will be counted against the employee's FMLA entitlement and specifies return-to-work requirements, such as fitness-for-duty certifications.

Document outline

1. Section I: Employer Designation and Notice 2. Section II: Additional Information Needed (Incomplete/Insufficient Certification) 3. Section III: FMLA Leave Approved (Leave Entitlement and Return-to-Work Requirements) 4. Paperwork Reduction Act Notice and Public Burden Statement

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