OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

The Family and Medical Leave Act of 1993, As Amended

OMB 1235-0003 · DOL/WHD.

OMB 1235-0003

This ICR implements statutory notice and certification provisions and to assist employees and employers in meeting their FMLA third-party notification obligations as required by the Family and Medical Leave Act of 1993 (FMLA). The subject recordkeeping requirements are necessary in order for the DOL to carry out its statutory obligation under FMLA section 106 to investigate and ensure employer compliance. 29 U.S.C. § 2616.

The latest form for The Family and Medical Leave Act of 1993, As Amended expires 2026-07-31 and is listed under ICR 202306-1235-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form WH-382 Designation Notice under the Family and Medical Leave ActForm and Instruction
Form WH-381 Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave ActForm and Instruction
Form WH-381 Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave ActForm and Instruction
Form WH-382 Designation Notice under the Family and Medical Leave ActForm and Instruction
Form WH-382 Designation Notice under the Family and Medical Leave ActForm and Instruction
Form WH-381 Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave ActForm and Instruction
Form WH-380-F Certification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave ActForm and Instruction
Form WH-380-E Certification of Health Care Provider for Employee's Serious Health Condition under the Family and Medical Leave ActForm and Instruction
Form WH-384 Certification for Military Family Leave for Qualifying Exigency under the Family and Medical Leave ActForm and Instruction
Form WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave under the Family and Medical Leave ActForm and Instruction
Form WH-385 Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave under the Family and Medical Leave ActForm and Instruction
Supporting Statement 1235-0003 v2.4 (2026-06-23).docxSupporting Statement A
60-day Notice - 91 FR 15642 (2026-03-30).pdfSupplementary Document
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Federal) Information collection
Notice to Employee of Pending Cancellation of Health Benefits (Federal) Information collection
Notice to Employee of FMLA Designation (Federal) Form and Instruction
Key Employee Notification (Federal) Information collection
Notice to Employee of Change of 12-Month Period for Determining Entitlement (State, local, tribal) Information collection
Notice to Employee of FMLA Eligibilty and Rights & Responsibilities (Federal) Form and Instruction
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (State, local, tribal) Form and Instruction
Notice to Employee of Pending Cancellation of Health Benefits (State, local, tribal) Information collection
Notice to Employee of FMLA Designation (State, local, tribal) Form and Instruction
General FMLA Recordkeeping (Federal) Information collection
Key Employee Notification (State, local, tribal) Information collection
General FMLA Recordkeeping (State, local, tribal) Information collection
Notice to Employee of Pending Cancellation of Health Benefits (Private Sector) Information collection
Documenting Family Relationship Information collection
Periodic Employee Status Report Information collection
Notice to Employee of FMLA Designation (Private Sector) Form and Instruction
General FMLA Recordkeeping (Private Sector) Information collection
Key Employee Notification (Private Sector) Information collection
Notice to Employee of Change of 12-Month Period for Determining Entitlement (Private Sector) Information collection
Employee's Notice of Need for FMLA Leave Information collection
Notice to Employee of FMLA Eligibility and Rights & Responsibilities (Private Sector) Form and Instruction
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction
Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202605-1235-003 Extension without change of a currently approved collection 2026-06-26
202306-1235-001 No material or nonsubstantive change to a currently approved collection 2023-06-06 Approved without change
202304-1235-001 Extension without change of a currently approved collection 2023-04-28 Approved with change
202302-1235-002 No material or nonsubstantive change to a currently approved collection 2023-02-27 Approved without change
201910-1235-001 Revision of a currently approved collection 2020-03-19 Approved without change
201711-1235-001 Extension without change of a currently approved collection 2018-04-20 Approved without change
201507-1235-001 No material or nonsubstantive change to a currently approved collection 2015-07-09 Approved without change
201410-1235-004 Revision of a currently approved collection 2015-02-25 Approved with change
201408-1235-001 No material or nonsubstantive change to a currently approved collection 2014-09-08 Approved without change
201404-1235-001 Revision of a currently approved collection 2014-06-27 Comment filed on proposed rule and continue
201303-1235-001 No material or nonsubstantive change to a currently approved collection 2013-03-27 Approved without change
201302-1235-001 Revision of a currently approved collection 2013-02-06 Approved without change
201207-1235-001 Revision of a currently approved collection 2013-01-24 Preapproved
201202-1235-002 Revision of a currently approved collection 2012-02-22 Comment filed on proposed rule and continue
201112-1235-003 Revision of a currently approved collection 2011-12-29 Approved without change
201003-1235-003 Revision of a currently approved collection 2010-03-12 Approved with change

OMB Details

Employee Certifications (Serious Health Condition, Recertification, Fitness-for-Duty; Call to Military Active Duty; Qualifying Exigency Due o Call to Military Active Duty; Servicemember Illness/Injuy

Federal Enterprise Architecture: Workforce Management - Labor Rights Management

Information collection instruments
FormNameElectronic accessType
Form WH-385Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave under the Family and Medical Leave Actwww.dol.gov/whd/forms/WH-385.pdfForm and instruction
Form WH-380-FCertification of Health Care Provider for Family Member's Serious Health Condition under the Family and Medical Leave Actwww.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-F.pdfForm and instruction
Form WH-380-ECertification of Health Care Provider for Employee's Serious Health Condition under the Family and Medical Leave Actwww.dol.gov/agencies/whd/fmlaForm and instruction
Form WH-384Certification for Military Family Leave for Qualifying Exigency under the Family and Medical Leave Actwww.dol.gov/whd/forms/WH-384.pdfForm and instruction
Form WH-385-VCertification for Serious Injury or Illness of a Veteran for Military Caregiver Leave under the Family and Medical Leave Actwww.dol.gov/whd/forms/wh385v.pdfForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.