Family anad Medical Leave Act Forms Comment Card

FMLA Forms Comment Card

This questionnaire is intended to solicit feedback on the U.S. Department of Labor Wage and Hour Division FMLA optional-use forms. Participation is voluntary and confidential. Please do not write your name or employer’s name on the comment sheet. We estimate respondents may take up to 10 minutes to answer all of the questions. The Paperwork Reduction Act provides that we could not ask for your feedback without such approval. Thank you for your willingness to provide your views on these forms.

OMB Control Number 1225-0088

Expiration 10/2020

This questionnaire concerns seven (7) forms free to the public for optional use in the administration of the Family and Medical Leave Act (FMLA):

• WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition

• WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition

• WH-381 Notice of Eligibility and Rights and Responsibilities

• WH-382 Designation Notice

• WH-384 Certification of Qualifying Exigency For Military Family Leave

• WH-385 Certification for Serious Injury or Illness of Covered Servicemember—for Military Family Leave

• WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave

Without identifying yourself or your company, please provide us with information about your FMLA leave administration experience:

I have ________ years of experience working in FMLA leave administration.

My current job title is ______________________________________.

In your answers to the following questions, please identify whether your response concerns a particular section, question, line, or instruction in a form or forms. Please do not respond to questions about a form unless you are familiar with it. Questions (9) and (10) are not specific to any individual form.

1. What feedback can you provide about the arrangement of content in forms WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition and WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition?

2. What feedback can you provide about the instructions or questions in forms WH-380-E and WH-380-F?

3. What feedback can you provide about the arrangement of content in form WH-381 Notice of Eligibility and Rights and Responsibilities?

4. What feedback can you provide about the instructions or other information in form WH-381?

5. What feedback can you provide about the arrangement of content in form WH-382 Designation Notice?

6. What feedback can you provide about the instructions or other information in form WH-382?

7. What feedback can you provide about the arrangement of content in forms WH-384 Certification of Qualifying Exigency for Military Family Leave, WH-385 Certification for Serious Injury or Illness of Covered Servicemember—for Military Family Leave and WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave?

8. What feedback can you provide about the instructions or questions in forms WH-384, WH-385 and WH-385-V?

9. The FMLA optional-use forms are available on the U.S. Department of Labor website and may be printed or saved as a downloadable pdf. What feedback can you provide about the availability of the forms in these formats (printable and downloadable pdf)?

10. Can you provide any additional feedback about the optional-use FMLA forms?

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