How to Fill Out and Submit an FMLA Request Form (WH-380-E)

To request FMLA leave for your own serious health condition, you fill out the identifying section of Form WH-380-E, give the form to your healthcare provider to complete the medical section, and return the signed certification to your employer within 15 calendar days of the request. Learning how to fill out FMLA Form WH-380-E correctly is what protects your leave: an incomplete or late certification is the most common reason FMLA requests get denied. The blank form is available at dol.gov/agencies/whd/fmla/forms.¹

What WH-380-E Is and When to Use It

WH-380-E is the Department of Labor’s medical certification form for an employee’s own serious health condition.² If your leave is to care for a family member, you need WH-380-F instead; military-related leave uses WH-384, WH-385, or WH-385-V. Your employer may substitute its own internal form, but any substitute must request the same categories of information the DOL version does.¹

A “serious health condition” for FMLA purposes means an illness, injury, or physical or mental condition that involves inpatient care or continuing treatment by a healthcare provider. Routine physicals, eye exams, and dental checkups do not qualify, and neither does a course of over-the-counter medication on its own.³

Before You Start: Confirm You’re Eligible

Filling out the form only helps if you and your employer are covered. You need 12 months of employment with the company (not necessarily consecutive), at least 1,250 hours worked in the 12 months before leave begins, and a worksite with 50 or more employees within a 75-mile radius. Private employers are covered if they had 50 or more employees during at least 20 workweeks in the current or previous year; public agencies and public and private elementary and secondary schools are covered regardless of size.⁴

Section I: What You Fill In

Section I is the identifying information at the top of the form. Either you or your employer can complete it. It asks for your name, your employer’s name, the date certification was requested, and the return deadline (which must be at least 15 calendar days out). It also asks for your job title, your regular work schedule, and a description of the essential functions of your job. If your employer attaches a separate job description, there’s a checkbox to indicate that.²

Get the essential job functions right before you hand the form to your doctor. In Section II, your provider has to state which of those functions your condition prevents you from performing, and vague or generic job descriptions here lead to vague answers there. If your employer hasn’t given you a written job description, list the specific physical and mental tasks your role actually requires: lifting weights, hours of standing, keyboard work, driving, decision-making under deadline, and so on.

Section II: What Your Healthcare Provider Fills In

Your healthcare provider completes Section II. Do not fill in medical information yourself, even if you know the answers. Section II has three parts.²

Part A: Medical Information

The provider enters their contact information and medical specialty, then documents when your condition began and how long it’s expected to last. They check which category applies from a list that includes inpatient care, incapacity plus continuing treatment, pregnancy, chronic conditions, permanent or long-term conditions, and conditions requiring multiple treatments. They can check more than one and add relevant medical facts.

Part B: Amount of Leave Needed

This is the part most often filled out too loosely. The provider lists dates of scheduled medical visits, any referrals to other providers, and whether you need a reduced work schedule. For continuous leave, they estimate the start and end dates. For intermittent leave, they must estimate how often flare-ups or episodes will occur and how long each one will last.⁵ Ask your provider to give a real frequency and duration, not a one-word answer. “As needed” is the kind of response that triggers an insufficiency letter and eats up your cure period.

Part C: Essential Job Functions

The provider states whether your condition prevents you from performing one or more of the essential job functions listed in Section I, and identifies which ones. They sign and date the form. Section I and Part C have to line up; that’s the whole point of getting the job description right on the front end.

Before you leave the doctor’s office, look over every question. Blank fields and non-responsive answers are the two things your employer is allowed to reject the certification for.

The 15-Day Deadline and How to Submit

Notice comes first, before the form. For foreseeable leave — a planned surgery, an expected due date, scheduled treatment — you must give your employer at least 30 days’ advance notice. If you learn about the need for leave less than 30 days out, or the need is unforeseeable, tell your employer the same day or the next business day.⁶

After you give notice, your employer generally requests certification within five business days. From the date of that request, you have 15 calendar days to return the completed WH-380-E. If genuine circumstances stop you from meeting the deadline despite diligent, good-faith efforts, you’re entitled to additional time, but forgetting or delaying isn’t a legitimate reason.⁷

Submit the completed form to your HR department or leave administrator through a method that creates a record: email with a read receipt, hand delivery with a signed acknowledgment, or a secure employer portal. Keep a copy of everything you send, along with the original request and any correspondence.

What Happens After You Turn It In

Once your employer has enough information to decide, it must send you a written Designation Notice (Form WH-382) within five business days. The notice tells you whether your leave is FMLA-qualifying and whether it will count against your 12-week entitlement.⁸

If the Form Is Incomplete or Insufficient

If your employer finds entries missing (incomplete) or answers vague or non-responsive (insufficient), it must tell you in writing exactly what more is needed. You then have seven calendar days to fix the problem. If you don’t cure the deficiency in that window, the employer can deny FMLA protection for the leave.⁷ The usual culprits are Part B frequency estimates and unchecked category boxes in Part A. Get back to your provider fast.

If You Miss the 15-Day Deadline

If you don’t return the certification within 15 calendar days and don’t have a legitimate reason, your employer can deny FMLA protection for leave taken after the deadline. Leave you took during the initial 15 days remains protected, and protection resumes once you eventually provide a complete certification, but the gap in between can be treated under your employer’s normal attendance policy. If you never provide the certification, none of the leave qualifies as FMLA-protected.⁵

If Your Employer Challenges the Certification

Your employer can require a second opinion at its own expense if it has reason to doubt the validity of your certification. While you wait for that opinion, you’re provisionally entitled to FMLA benefits, including continued group health coverage. The employer chooses the second provider, but that provider cannot be someone the employer regularly employs or contracts with unless healthcare access in the area is very limited.⁹

If the first and second opinions disagree, a third opinion can be required, also at the employer’s expense. You and the employer must jointly choose the third provider in good faith; that opinion is final and binding on both sides.¹⁰

One privacy limit runs through all of this: your direct supervisor may never contact your healthcare provider. Only an HR professional, leave administrator, management official, or another healthcare provider acting on the employer’s behalf may reach out, and only to authenticate or clarify the certification.⁵

Recertification Later On

Filing WH-380-E once doesn’t necessarily end the paperwork. Your employer can request updated certification no more often than every 30 days in connection with an actual absence, and if your original certification lists a minimum duration longer than 30 days, the employer must wait until that period ends. For ongoing conditions, the employer may request recertification every six months regardless of the stated duration.⁵ Recertification can come sooner if you request an extension, if the circumstances in your original certification change significantly, or if the employer receives information that casts doubt on the stated reason for your absence.

1
U.S. Department of Labor. FMLA: Forms
2
U.S. Department of Labor. Certification of Health Care Provider for Employees Serious Health Condition under the Family and Medical Leave Act
3
eCFR. 29 CFR 825.113 – Serious Health Condition
4
U.S. Department of Labor. Fact Sheet 28 – The Family and Medical Leave Act
5
U.S. Department of Labor. Fact Sheet 28G – Medical Certification under the Family and Medical Leave Act
6
eCFR. 29 CFR 825.302 – Employee Notice Requirements for Foreseeable FMLA Leave
7
eCFR. 29 CFR 825.305 – Certification, General Rule
8
eCFR. 29 CFR 825.300 – Employer Notice Requirements
9
eCFR. 29 CFR 825.307 – Authentication and Clarification of Medical Certification
10
U.S. Department of Labor. Family and Medical Leave Act Advisor