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Departments & Divisions Industrial
Relations Family
and Medical Leave Act (FMLA) FMLA
Forms 
Departments & Divisions Industrial
Relations Family
and Medical Leave Act (FMLA) FMLA
Forms Mike Morris, Director |
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Family and Medical Leave Act (FMLA) Forms
Union Encourages Members to Use
Department of Labor Forms for FMLA Leave Requests
(12/17/10) The APWU is encouraging members to use Department of Labor forms when requesting Family & Medical Leave, while the union pursues a dispute with the Postal Service over employees’ right to use APWU forms or other equivalent documentation.
In a Dec. 17, 2010, memo [PDF] to local, state, and national union officers, Mike Morris, director of Industrial Relations, wrote that the APWU continues to assert that use of Department of Labor (DOL) forms are optional. Under the Family & Medical Leave Act (FMLA), medical certification provided in any format must be accepted, as long as it contains all of the information required under the law, he said.
Despite the APWU’s position, Morris said, the union is encouraging employees to use the DOL Forms WH-380E and WH-380F until such time as a national-level grievance [PDF] on the issue is resolved. The union filed a dispute on the matter, after management notified the APWU of its intent to require employees to use the DOL forms.
In the past, the union encouraged members to use forms offered by the APWU, because the DOL forms ask physicians to provide some information that is not required by FMLA regulations.
Certification By Employee’s Health Care Provider For Employee’s Serious Health Condition
Certification Of Health Care Provider For Family Member’s Serious Health Condition
Certification Of Qualifying Exigency For Military Family Leave
Certification For Serious Injury Or Illness Of Covered Servicemember For Military Family Leave
(02/02/12) Note: The forms provided above have an expiration date, Feb. 29, 2012, and the Department of Labor (DOL) indicates that the forms’ expiration dates will be extended on a month-to-month basis until their review is completed by the Office of Management and Budget (OMB). However, note that content of the forms will remain the same during OMB review. Under the Paperwork Reduction Act (PRA), review by OMB is required for all federal agency forms every three years.
In response to DOL’s Federal Register notice last fall seeking public comment on continuing the forms, APWU joined other unions and the National Partnership for Women & Families in recommending that some changes be made to the forms. DOL, however, has not proposed modifying the forms. OMB can renew these forms after an additional public comment period ends on Jan. 30, 2012, which is the deadline listed in the final Federal Register notice for commenting on these forms. DOL anticipates that OMB will conclude its review very soon.
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Sample Completed APWU Forms
Sample Form for Employee's Absence Plus Treatment
Sample Form for Child with Chronic Condition
Sample Form for Chronic Condition
Sample Form for Long Term-Terminal Illness
Sample Form for Multiple Treatments
