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PaidFillable AcroFormUnited States
FMLA Certification of Health Care Provider for Family Member's Serious Health Condition - DOL Form WH-380-F (Revised June 2020, OMB Exp. 8/31/2029)
Fillable PDF form with 85 form fields over 4 pages. Category: Nursing & Healthcare Support › General.
| Format | PDF (AcroForm) |
|---|---|
| Pages | 4 |
| Form fields | 85 fillable fields |
| Jurisdiction | United States |
| Field / type | Nursing & Healthcare Support › General |
| Version (last updated) | 2026-10-16 |
| Licence | US-gov-PD (checked 2026-10-16) |
| Attribution | Source: U.S. Department of Labor, Wage and Hour Division, Form WH-380-F (Revised June 2020, OMB 1235-0003, Exp. 8/31/2029), dol.gov (U.S. Government work, 17 U.S.C. 105). Prepared by FormSphere as a fillable AcroForm; not affiliated with or endorsed by the U.S. Department of Labor. |
Please check this template for currency and for your local requirements before using it. It is a blank template, not legal advice and not a guarantee of compliance.