Form Wh 382 PDF Details

Understanding the WH-382 Form is critical for employees who find themselves in need of leave covered under the Family and Medical Leave Act (FMLA). Administered by the U.S. Department of Labor's Wage and Hour Division, this form acts as a Designation Notice, crucially informing employees whether their leave request has been approved under the FMLA and detailing the amount of leave that will be deducted from their FMLA leave entitlement. It plays a vital role in ensuring both employers and employees adhere to the FMLA requirements, providing a structured method for communicating decisions regarding leave requests. Employers may ask for a certification to support the leave request; if this certification is deemed incomplete or insufficient, the employer is required to outline what additional information is necessary. The form outlines various scenarios, including approval of FMLA leave, requirements for paid leave usage during FMLA leave, the necessity of a fitness-for-duty certification upon return to work, and situations where additional information is required to approve the leave request. It also addresses the circumstances under which an employer might request a second or third opinion on medical certification, at the employer's expense. Notably, it underscores the importance of keeping employees informed, as mandated by law, about their leave status and their rights under the FMLA, ensuring transparency and compliance throughout the process.

QuestionAnswer
Form NameForm Wh 382
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform wh 382, 2018, form, nw

Form Preview Example

Designation Notice

U.S. Department of Labor

(Family and Medical Leave Act)

Wage and Hour Division

 

OMB Control Number: 1235-0003

Expires: 2/28/2015

Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA-protected and the employer must inform the employee of the amount of leave that will be counted against the employee’s FMLA leave entitlement. In order to determine whether leave is covered under the FMLA, the employer may request that the leave be supported by a certification. If the certification is incomplete or insufficient, the employer must state in writing what additional information is necessary to make the certification complete and sufficient. While use of this form by employers is optional, a fully completed Form WH-382 provides an easy method of providing employees with the written information required by 29 C.F.R. §§ 825.300(c), 825.301, and 825.305(c).

.

To: ______________________________________

Date: _____________________________

We have reviewed your request for leave under the FMLA and any supporting documentation that you have provided.

We received your most recent information onand decided:

_____ Your FMLA leave request is approved. All leave taken for this reason will be designated as FMLA leave.

The FMLA requires that you notify us as soon as practicable if dates of scheduled leave change or are extended, or were initially unknown. Based on the information you have provided to date, we are providing the following information about the amount of time that will be counted against your leave entitlement:

_____ Provided there is no deviation from your anticipated leave schedule, the following number of hours, days, or weeks will be

counted against your leave entitlement: _____________________________________________

_____ Because the leave you will need will be unscheduled, it is not possible to provide the hours, days, or weeks that will be counted

against your FMLA entitlement at this time. You have the right to request this information once in a 30-day period (if leave was taken in the 30-day period).

Please be advised (check if applicable):

_____ You have requested to use paid leave during your FMLA leave. Any paid leave taken for this reason will count against your

FMLA leave entitlement.

_____ We are requiring you to substitute or use paid leave during your FMLA leave.

______You will be required to present a fitness-for-duty certificate to be restored to employment. If such certification is not timely

received, your return to work may be delayed until certification is provided. A list of the essential functions of your position

___ is ___ is not attached. If attached, the fitness-for-duty certification must address your ability to perform these functions.

_____ Additional information is needed to determine if your FMLA leave request can be approved:

_____ The certification you have provided is not complete and sufficient to determine whether the FMLA applies to your leave

request. You must provide the following information no later than ______________________________, unless it is not

(Provide at least seven calendar days)

practicable under the particular circumstances despite your diligent good faith efforts, or your leave may be denied.

____________________________________________________________________________________________________

(Specify information needed to make the certification complete and sufficient)

____________________________________________________________________________________________________

_____ We are exercising our right to have you obtain a second or third opinion medical certification at our expense, and we will

.provide further details at a later time.

_____ Your FMLA Leave request is Not Approved.

The FMLA does not apply to your leave request.

You have exhausted your FMLA leave entitlement in the applicable 12-month period.

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

It is mandatory for employers to inform employees in writing whether leave requested under the FMLA has been determined to be covered under the FMLA. 29 U.S.C. § 2617; 29 C.F.R. §§ 825.300(d), (e). It is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 10 – 30 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210. DO NOT SEND THE COMPLETED FORM

TO THE WAGE AND HOUR DIVISION.

Form WH-382 January 2009

How to Edit Form Wh 382 Online for Free

If you want to fill out FMLA, you won't need to download and install any sort of programs - simply use our PDF editor. The editor is consistently upgraded by our staff, acquiring additional features and becoming greater. Getting underway is effortless! Everything you need to do is stick to the following basic steps down below:

Step 1: Just hit the "Get Form Button" above on this site to launch our pdf form editing tool. Here you will find everything that is necessary to work with your file.

Step 2: With our handy PDF editor, you could accomplish more than merely fill in forms. Try each of the functions and make your forms seem sublime with customized textual content added, or tweak the original content to perfection - all that backed up by the capability to incorporate almost any graphics and sign it off.

In order to complete this form, ensure that you type in the information you need in every blank:

1. To start off, once filling in the FMLA, start with the form section containing subsequent fields:

Part number 1 of filling out wh382

2. When the previous array of fields is done, you need to put in the essential specifics in We are requiring you to, Additional information is needed, We are exercising our right to, provide further details at a later, Your FMLA Leave request is Not, You have exhausted your FMLA leave, PAPERWORK REDUCTION ACT NOTICE AND, It is mandatory for employers to, and Form WH January so that you can move forward to the 3rd stage.

You have exhausted your FMLA leave, Your FMLA Leave request is Not, and We are exercising our right to of wh382

It's easy to make an error when completing your You have exhausted your FMLA leave, for that reason be sure you go through it again before you submit it.

Step 3: Go through the details you have typed into the form fields and hit the "Done" button. After creating a7-day free trial account here, it will be possible to download FMLA or email it right away. The PDF document will also be accessible via your personal cabinet with your every modification. Whenever you work with FormsPal, you're able to complete forms without needing to be concerned about information breaches or data entries getting shared. Our secure system makes sure that your personal data is kept safely.