DoL WH-382 2009 free printable template
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Designation Notice
(Family and Medical Leave Act)U.S. Department of Labor
Wage and Hour Division OMB Control Number: 12350003
Expires: 8/31/2021
Leave covered under the Family and Medical Leave Act
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DoL WH-382 Form Versions
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How to fill out 382 form
How to fill out DoL WH-382
01
Obtain the DoL WH-382 form from the Department of Labor website or your employer's HR department.
02
Fill out the employee's name, address, and contact information in the designated sections.
03
Indicate the purpose of the leave by selecting the relevant option from the provided choices.
04
Provide details about the medical condition, including the name of the healthcare provider and their contact information.
05
Specify the expected duration of the leave and any relevant start and end dates.
06
Sign and date the form to certify the information is accurate.
07
Submit the completed form to your employer's HR department or designated leave administrator.
Who needs DoL WH-382?
01
Employees who require a leave of absence for family and medical reasons under the Family and Medical Leave Act (FMLA).
02
Individuals seeking job protection while taking medical leave or caring for a family member with a serious health condition.
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People Also Ask about
How do I get FMLA in Michigan?
To be eligible for FMLA, you must have 12 months of employment with the State of Michigan (does not need to be consecutive) and you must have physically worked 1,250 hours within the previous 12 months. For questions on FMLA eligibility, contact the Disability Management Unit (DMU) by phone at 877-443-6362.
How to apply for FMLA in Michigan?
To apply for a Medical Leave, you must: Complete and submit the Application for Leave of Absence form to the Disability Management Unit (DMU). Have your health care provider complete and submit the Certification of Employee's Serious Health Condition form to the DMU. Completed forms may be faxed or mailed to the DMU:
What is the longest you can take FMLA?
The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave.
How do I get paid for FMLA in Michigan?
FMLA is unpaid, however, during an FMLA-approved leave: you may use leave credits to receive pay during your time off. If you have no leave credits, you may take the time unpaid. If you're enrolled in LTD, you may apply for disability benefits by contacting Sedgwick at 800-324-9901.
What is form 382?
Designation Notice, form WH-382 – informs the employee whether the FMLA leave request is approved; also informs the employee of the amount of leave that is designated and counted against the employee's FMLA entitlement.
What are the rules around FMLA?
In order to be eligible to take leave under the FMLA, an employee must (1) work for a covered employer, (2) work 1,250 hours during the 12 months prior to the start of leave, (3) work at a location where 50 or more employees work at that location or within 75 miles of it, and (4) have worked for the employer for 12
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What is DoL WH-382?
DoL WH-382 is a form used to request leave under the Family and Medical Leave Act (FMLA). It is specifically used for employees to notify their employers about the need for leave due to qualifying medical or family reasons.
Who is required to file DoL WH-382?
Employees who are eligible for FMLA leave and wish to take leave for their own serious health condition, to care for a family member, or for a qualifying exigency are required to file DoL WH-382.
How to fill out DoL WH-382?
To fill out DoL WH-382, an employee must provide their personal information, detail the reasons for the leave, specify the duration of the leave, and may need to provide supporting medical documentation from a healthcare provider if applicable.
What is the purpose of DoL WH-382?
The purpose of DoL WH-382 is to formalize the request for FMLA leave, ensuring that employers are notified about the need for leave and can assess eligibility under the FMLA guidelines.
What information must be reported on DoL WH-382?
The information that must be reported on DoL WH-382 includes the employee's name, the reason for the leave, the expected duration of leave, the relationship to the family member if applicable, and any additional supporting information as needed.
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