skip navigational linksDOL Seal - Link to DOL Home Page
Photos representing the workforce - Digital Imagery© copyright 2001 PhotoDisc, Inc.
www.dol.gov
November 5, 2008    DOL Home > Find It! By Form > DOL Form   

DOL Form WH-380

View ESA-WHD's Form 1215-0181 Online htm
Agency: ESA-WHD
Title: Family and Medical Leave Act of 1993 (Certification of Health Care Provider)
Form Description: The Certification of Health Care Provider is an optional form that an employer may use if it chooses to require certification from a health care provider that a serious health condition requiring leave under the Family and Medical Leave Act (FMLA) exists.
OMB Control Number: 1215-0181
OMB Expiration Date: Thursday, September 30, 2010




Phone Numbers