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USDOLRev. 06-2023

Official form guide

Form WH-382: Designation Notice (FMLA)

Official employer designation of whether leave qualifies as FMLA leave. Employers must provide this within 5 business days of having enough information to determine if the leave qualifies.

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Form Overview

DOL Form WH-382 - Designation Notice (FMLA)

Official employer designation of whether leave qualifies as FMLA leave. Employers must provide this within 5 business days of having enough information to determine if the leave qualifies.

An official designation notice that tells employees whether their leave counts as FMLA leave.

Risk Radar

Scan points
  • 1Employer not providing notice within 5 business days — may lose ability to retroactively designate leave as FMLA.
  • 2Employee not tracking FMLA hours used — important to know remaining FMLA time.
  • 3Employer failing to note fitness-for-duty requirement — must inform employee before leave ends.

Plain English

This form tells you whether your leave has been officially approved as FMLA leave and counts toward your 12-week annual entitlement.

Submission Date

  • Filing date: Employer must provide within 5 business days of having sufficient information to determine FMLA qualification.
  • Preparation window: collect IDs, supporting records, and signatures in advance.
  • Final review: verify names, dates, and required fields before submission.

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Glossary Terms

officialnotice

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Field map

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6 fields

Employee Info

1 items

Employee Name

Employee's name.

Requiredtext

Designation

2 items

FMLA Designation Decision

Whether the leave is designated as FMLA qualifying.

Requiredselect
Reason Not Designated

If not designated, the reason.

text

Leave Amount

1 items

Amount of Leave Needed

How much leave (continuous or intermittent) is designated.

Requiredtext

Return

1 items

Fitness for Duty Required

Whether a fitness-for-duty certification is required before returning.

Requiredcheckbox

Signature

1 items

Employer Signature

Authorized HR or employer representative signature.

Requiredsignature

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Quick Facts

Completed by employers and given to employees after determining FMLA qualification.
An official designation notice that tells employees whether their leave counts as FMLA leave.
Employer must provide within 5 business days of having sufficient information to determine FMLA qualification.
Employer provides to employee.
Without this designation, leave may not count against FMLA entitlement even if qualifying.
Employer completes the designation decision and any conditions (e.g., fitness-for-duty certification required upon return).

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Source transparency

Copyright & Licensing - US Government Forms

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Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
Public DomainCreated by the U.S. federal government. Not subject to copyright (17 USC § 105). Freely copyable without restriction.
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