Form WH-381 — Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act

What is Form WH-381?

When an employee tells you they need leave that may be covered by the Family and Medical Leave Act, you have five business days to tell them whether they are eligible and what their rights and responsibilities are. Form WH-381, from the Department of Labor's Wage and Hour Division, combines both notices in one document. The form is optional, but a fully completed WH-381 gives the employee the information required by 29 C.F.R. § 825.300(b) and (c).

Page 1 records the request: the date you learned of the need for leave, when the leave begins, and the reason, with the family relationship where it matters. Section I says whether the employee is eligible (in general, 12 months of service, 1,250 hours in the past 12 months, and a worksite with 50 employees within 75 miles) or which requirement they miss. Section II lists any certification, relationship documentation or other information you need and when it's due. Section III, the longest part, explains the leave entitlement and how your 12-month period is measured, key employee status, paid leave substitution, health and other benefits, premium grace periods, and any periodic status reports.

With FileIt, HR teams and small employers answer each part in a guided form, with the employee's name pre-filled from People in the vault. FileIt prints the answers into the Department of Labor's PDF, the employee's name on every page, and keeps the result in your vault. You give the notice to the employee. Nothing is sent to the Department of Labor.

Who needs to fill out Form WH-381?

• FMLA-covered employers whose employee has asked for leave for a new child, a serious health condition, a family member's care or a military family reason.
• HR departments that want a consistent written eligibility notice for every leave request.
• Small employers handling their first FMLA request and wanting the Department of Labor's own wording.
• Employers who need to tell an employee they aren't eligible yet because of months of service, hours worked, flight crew hours or worksite size.
• Employers requesting a medical or exigency certification together with the eligibility notice.

When to use Form WH-381

• Within five business days after an employee first asks for FMLA leave or you learn the leave may qualify.
• Together with the certification form you're asking for, such as WH-380-E, WH-380-F or WH-384, which you can attach.
• Before you designate the leave on Form WH-382, once you have the information you need.

What you need before you start

• The employee's name, the date you learned of the need for leave, and the date leave begins.
• The reason for the leave and, for family or military reasons, how the employee is related.
• The employee's months of service and hours worked in the last 12 months, if they may not be eligible.
• Which certification you want and the return date, at least 15 calendar days out.
• How your organization measures the 12-month FMLA period, and whether the employee is a key employee.
• Your paid leave rules and where they're published, who handles health premiums and other benefits, the premium grace period, and how often status reports are due.

What’s on Form WH-381

The 2020 edition has 4 pages. FileIt asks for it in 4 parts:

1. Leave requestEmployer
2. Section I: Notice of eligibilityEmployer
3. Section II: Additional information neededEmployer
4. Section III: Notice of rights and responsibilitiesEmployer

How to fill out Form WH-381, step by step

1 The request

Enter the date of the notice, your company and the employee's name, the date you learned the employee needs leave and the date it begins. Tick the reason: bonding with a new child, the employee's own serious health condition, caring for a family member, a qualifying exigency, or caring for a covered servicemember. For the last three, tick how the employee is related. The form explains that "child" and "parent" include in loco parentis relationships.

2 Section I — Eligibility

Tick Eligible, or Not eligible with one reason: under 12 months of service (with the approximate months worked), under 1,250 hours (with the approximate hours), an airline flight crew employee short of the special hours requirement, or a worksite with fewer than 50 employees within 75 miles. Add a contact for questions.

3 Section II — Additional information needed

Say either that no more information is needed, or what you want: a certification (from the employee's provider, the family member's provider, for a qualifying exigency, or for military caregiver leave), whether that form is attached, and a return date that allows at least 15 calendar days; documentation or a statement of the family relationship; or other information, such as military family leave paperwork. Each request gets its own due date.

4 Section III — Parts A and B

Part A: choose how your 12-month period is calculated (calendar year, a fixed leave year such as a fiscal year, forward from first use, or rolling backward), the start of any single 12-month military caregiver period, and whether the employee is a key employee. Part B: tick which paid leave rules apply, whether some leave is unpaid, the employee asked to use paid leave, you require it, or another benefit such as disability runs alongside, and where the paid leave conditions are written down.

5 Section III — Parts C to F

Part C: who to contact about paying health premiums during unpaid leave, and the grace period for late payments, 30 days or longer. Part D: who to contact about other benefits. Part E explains reinstatement rights and needs no answers. Part F: whether the employee must send periodic reports on their status and intent to return, and how often.

Common mistakes to avoid

• Sending the notice after the five-business-day window.
• Giving less than 15 calendar days to return a medical certification.
• Marking an employee not eligible without the approximate months or hours worked that show the shortfall.
• Ticking "no additional information requested" and then asking for a certification anyway.
• Leaving the 12-month leave year blank, so the employee can't tell how much leave remains.
• Forgetting the contact for health insurance premiums, which matters most during unpaid leave.
• Mailing the notice to the Department of Labor instead of giving it to the employee.

After you fill it out

Give the notice to the employee, with any certification form you've asked for, and keep a copy: the burden statement says employers must retain it for three years. FileIt keeps the filled PDF in your vault.

Follow up on the due dates you set in Section II. Once you have the information, you'll designate the leave in writing within 5 business days, usually on Form WH-382.

Part F reminds the employee to tell you at least two workdays before returning early, so note any early return date they give you.

Form WH-381: frequently asked questions

Official sources

• Blank form (PDF), published by U.S. Department of Labor, Wage and Hour Division: https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-381.pdf
• Official instructions and guidance: https://www.dol.gov/agencies/whd/fmla
• Edition shown on this page: Revised June 2020 (OMB 1235-0003, expires 8/31/2029) (checked 2026-10-19).

FileIt is not affiliated with or endorsed by U.S. Department of Labor, Wage and Hour Division or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-19.

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