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You may have noticed that your FMLA notice and certification forms have an expiration date of December 31, 2011. No need to worry though. The DOL has issued “new” forms. These forms are virtually identical to the existing forms, but contain a February 28, 2015 expiration date. Here are links to the new forms:

  • Certification of Health Care Provider for Employee’s Serious Health Condition (WH-380-E)
  • Certification of Health Care Provider for Family Member’s Serious Health Condition (WH-380-F)
  • Notice of Eligibility and Rights and Responsibilities (WH-381)
  • Designation Notice (WH-382)
  • Certification of Qualifying Exigency for Military Family Leave (WH-384)
  • Certification of Serious Injury or Illness of Covered Servicemember – for Military Family Leave (WH-385)

Unfortunately, the new forms do not contain the proposed “safe harbor” language relative to disclosure of genetic information under the Genetic Information Nondisclosure Act (“GINA”). In order to avoid liability for disclosure of such information, the DOL has recommended inserting the following safe harbor language into medical request forms:

The Genetic Information Nondisclosure Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. ‘Genetic Information’ as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.


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