Form WH-384 — Certification of Qualifying Exigency for Military Family Leave (FMLA)

What is Form WH-384?

The Family and Medical Leave Act lets an eligible employee take leave for a "qualifying exigency" while their spouse, child or parent, the military member, is on covered active duty or has been notified of an impending call or order to it. Qualifying exigencies are things like a short-notice deployment, military ceremonies and briefings, arranging childcare, care for the military member's parent, financial and legal arrangements, counseling, the member's Rest and Recuperation leave, and post-deployment events. An employer may require a certification to support the leave, and Form WH-384 is the Department of Labor's form for it.

The form is optional, but it asks for exactly what a complete and sufficient certification needs under 29 C.F.R. § 825.309, and the employer may not ask for more. Section I, which either side may fill in, names the employee and employer and sets the return date, at least 15 calendar days after the request. Section II is the employee's: Part A identifies the military member and their covered active duty with supporting documents, Part B the exigency category and facts, Part C the leave needed (dates, a reduced schedule, a continuous absence, intermittent absences, or R & R dates), and Part D any third party the employer may contact to verify a meeting. The employee then signs.

In FileIt you fill each part in a guided form, with your own name pre-filled from People in your vault, and the answers printed into the Department of Labor's own PDF with your name on every page. You can sign it by e-signature or by hand, and the copy stays in your vault. The completed form goes to your employer, never to the Department of Labor.

Who needs to fill out Form WH-384?

• Employees whose spouse, child or parent is deploying, or has been called up, with the Armed Forces to a foreign country.
• Military spouses who need time off for a pre-deployment briefing, to set up childcare, or to handle legal and financial paperwork.
• Employees who want to spend time with a family member home on short-term Rest and Recuperation leave.
• Employees attending arrival ceremonies, reintegration events or counseling after a deployment.
• Employers and HR teams who are asking for a qualifying exigency certification and want to fill in Section I.

When to use Form WH-384

• When your employer asks you to certify a request for FMLA leave because of a family member's covered active duty.
• After you've received the Notice of Eligibility (WH-381) with a request for this certification.
• Once for each military member and deployment: the form says the active duty documents only need to be given once unless the leave is for a different member or deployment.
• Before the return date in Section I. If a complete and sufficient certification isn't provided, the leave request may be denied.
• For leave to care for a covered servicemember with a serious injury or illness, a different certification is used, not this one.

What you need before you start

• Your name, your employer's name, the date the certification was requested and the return-by date.
• The military member's full name, how they are related to you, and the dates of their covered active duty service.
• A copy of the member's active duty orders or other military documentation, unless you have already given it to your employer.
• The type of exigency and any written documentation, such as a briefing announcement or an R & R leave confirmation.
• Dates for when the exigency starts and how long it lasts, and how you'll take the leave: reduced schedule, continuous dates, or how often and how long intermittent absences will be.
• For a meeting with a third party: their name or organization, address, phone, fax, email and the purpose of the meeting.

What’s on Form WH-384

The 2020 edition has 4 pages. FileIt asks for it in 6 parts, and it is signed by Employee:

1. Section I: EmployerEmployer (or employee)
2. Section II, Part A: Covered active duty statusEmployee
3. Section II, Part B: Appropriate factsEmployee
4. Section II, Part C: Amount of leave neededEmployee
5. Section II, Part D: Third party informationEmployee
6. SignatureEmployee

How to fill out Form WH-384, step by step

1 Section I — Employer

Enter the employee's first, middle and last name, the employer's name, the date the certification was requested and the date it must be returned by. The form says the return date must allow at least 15 calendar days, unless that isn't feasible despite the employee's diligent, good faith efforts.

2 Part A — Covered active duty status

Give the military member's name and whether they are your spouse, parent or child of any age (in loco parentis relationships count). Enter the dates of their covered active duty service, and tick which document you're attaching: a copy of the orders, other military documentation such as official correspondence from the chain of command, or a note that you've already provided enough documentation.

3 Part B — Appropriate facts

Tick the qualifying exigency category, or more than one if they apply, and add details where the form asks: military events, childcare, care for the member's parent, post-deployment activities, or another event you and your employer agree is a qualifying exigency. Say whether written documentation of the event is attached, not attached or not available.

4 Part C — Amount of leave needed

Give the approximate date the exigency started or will start and how long it will last. Then fill in what applies: a reduced schedule with dates and the hours you can work, a continuous absence with dates, intermittent absences with how many times per day, week or month over the next 6 months and how many hours or days each lasts, and the dates of the member's R & R leave. The form warns that "unknown" or "indeterminate" may not be enough.

5 Part D — Third party and signature

If the leave involves a meeting with a third party, such as a counselor, school, care facility or lawyer, give their name or organization, address, phone, fax, email and the meeting's purpose, so your employer can verify it. Then sign and date page 4. FileIt prints the date and can send the PDF for e-signature.

Common mistakes to avoid

• Using this form for leave to care for an injured or ill servicemember. That's military caregiver leave, which has its own certification.
• Forgetting to attach the active duty orders or other military documentation the first time you certify a deployment.
• Writing "unknown" for the dates or frequency of leave instead of a best estimate.
• Ticking a category such as military events or childcare without giving the details the form asks for.
• Expecting more than 15 calendar days of leave for each instance of the member's Rest and Recuperation leave.
• Missing the return date your employer set in Section I.
• Sending the form to the Department of Labor instead of returning it to your employer.

After you fill it out

Sign and date the form, attach the military documentation and any event documents, and return it to your employer by the date in Section I. FileIt saves the filled PDF in your vault.

Your employer reviews the certification and will tell you in writing whether the leave is designated as FMLA leave, often on the Designation Notice, Form WH-382.

The employer may use the Part D details to verify a third-party meeting, and must keep a copy of the certification for three years, according to the form's burden statement.

Form WH-384: 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-384.pdf
• Official instructions and guidance: https://www.dol.gov/agencies/whd/fmla/military-family-leave
• 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.

Related forms

All United States forms · Every form FileIt can fill