Federal employment leave
FMLA Family Member Care Certification (Form WH-380-F)
Certify FMLA leave to care for a family member with a serious health condition
What is Form 380-F used for?
Form WH-380-F is the Department of Labor's optional form for certifying that an employee needs FMLA leave to care for a family member with a serious health condition.
Return a complete certification to the employee within the employer's deadline.
Use WH-380-E instead if the leave is for the employee's own serious health condition.
Time, difficulty & who this form is for
Average time
15-25 minutes
Difficulty
detail-heavy
Best for
Employees and health care providers certifying family-care FMLA leave.
What do I need before I start?
- Employee and employer details from Section I
- Family member name, relationship, and care you will provide (Section II)
- Provider medical facts about the patient's condition and leave timing
How the walkthrough is organized
Employer and employee context
Who is requesting leave and certification deadlines.
Your care plan
Family member, relationship, and care you will provide.
Medical condition type
Which serious health condition categories apply to the patient.
Leave amount needed
Treatment dates, incapacity, and intermittent care absence.
What happens after I complete it?
Answer the questions, review your document, then follow its official signing and delivery instructions. Downloading does not submit the form.
Start dol-wh-380f-fmla-family-member-healthcare-certification walkthrough