Full List of FMLA Forms and Leave Forms from Federal and State Government.

For more information visit Qcera Homepage or LeaveSource

Federal FMLA Forms

FMLA WH 381 Notice of Eligibility and Rights & Responsibilities
FMLA WH 382 Designation Notice
FMLA WH-384 Certification of Qualifying Exigency For Military Family Leave
FMLA WH 385 Certification for Serious Injury or Illness for Military Family Leave
FMLA WH 385V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
FMLA WH 380E Certification of Health Care Provider for Employees Serious Health Condition
FMLA WH 380F Certification of Health Care Provider for Family Members Serious Health Condition
FMLA Employee Rights and Responsibilities

State Forms

California

CalHR-754 Certification of Health Care Provider for Employees Serious Health Condition
DFEH-186 Pregnancy Leave
Paid Family Leave Benefits DE 2511
Fact Sheet DE 8714CF Paid Family Leave (PFL)
Fact Sheet DE 8714DI State Disability Insurance (SDI)
Notice to Employees DE 1858
Unemployed Insurance DE 1857A

Connecticut

CT MedCert (Certification of Health Care Provider)
CT FMLA-Guidance
CT FMLA Statute

D.C.

FML DCSF No. FML‐01 (Family and Medical Leave Application Form)
FML Paid Family Leave Bulletin DCHR 12 294
FML Paid Family Leave Questions and Answers

Hawaii

Family Leave Comparison Chart

Massachusetts

WH-382 MA (Designation Notice)
Employee Notice of Family or Medical Leave
Medical Certification
Fitness for Duty Certification
Certificate of Health Care Provider for Employee's Serious Health Condition

Certification of Health Care Provider for Family Member's Serious Health Condition (Appendix G-4)
Return to Work Form (Employee Notice of Intention to Return)
Employer Response (Notice of Eligibility and Rights & U.S. Department of Labor Responsibilities)

Minnesota

Parental Leave
Sick and Safe Leave
Pregnancy Leave Nursing Mothers

New Jersey

FLA DCF-III-A-1-005.2007 (Department of Children and Families Policy Manual)

Oregon

OFLA Forms Packet
OFLA Employee Leave Request Form CD1D 01-12
OFLA EMSR Employee Medical Status Report
OFLA Medical Certificate Employee (For Employee's Serious Health Condition PD 615A)
OFLA Medical Certificate Family Member (Family Member's Serious Health Condition Form)
OFLA Notice to Employers and Employees (Poster)
OFLA SHC Certification for Serious Health Condition

Rhode Island

Medical Leave Rules and Regulation
TDI Release Form (Authorization for Release of Medical Information)
DWC 27_28 (Physician's Notice of Release to Work)

Vermont

Military Leave Rights
WH-14 Parental Leave, Family Leave, Short Term Family Leave Poster
Nursing Mothers Fact Sheet (Workplace Support Nursing Moms)

Washington

F700-144-000 Protected Leave Complaint Form (11-2009)
Domestic Violence Leave for Victims and Family Members
USERRA (Uniformed Services Employment and Reemployment Rights Act)
Job Protected Family Leave Laws Table
Family Leave Act FAQs
Family Care Act FAQs ES.C.10
Washington State Military Family Leave Act Question and Answer (Leave Form Military Spouses)

Wisconsin

Complaint (ERD_8994)

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