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Certification of Health Care Provider for 
Family Member’s Serious Health Condition 
under the Family and Medical Leave Act WH-

ICR 202302-1235-002 · OMB 1235-0003 · Object 129544201.

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Document Metadata
File Typeapplication/pdf
File TitleCertification of Health Care Provider for 
Family Member’s Serious Health Condition 
under the Family and Medical Leave Act WH-
SubjectWHD
AuthorU.S. Department of Labor
File Modified2023-02-08
File Created2023-01-25
Conversion Statepartial