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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 202306-1235-001 · OMB 1235-0003 · Object 132348201.

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application/pdf
Certification of Health Care Provider for 
Family Member’s Serious Health Condition 
under the Family and Medical Leave Act WH-
WHD
U.S. Department of Labor
2023-02-08
2023-01-25
partial