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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)
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) is a blank, fillable PDF (AcroForm) with 85 fillable fields over 4 pages. It is filed under Nursing & Healthcare Support › General and relates to United States.
Made for people and organisations working in nursing & healthcare support who need the United States document in a clean, fillable form.
| 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. |
Where this document comes from
| Origin | Official form published by dol.gov |
|---|---|
| Licence | US federal government work (public domain) |
| Rights checked | 2026-10-16 |
| PDF check | 85 fillable fields over 4 pages, blank |
| Status | Preview only: licence review in progress |
What you get over the free original
- The publisher's original is free at dol.gov. We link to that source and do not replace it.
- A clean, blank AcroForm: every field empty, working in any PDF reader, with wording, page order and layout unchanged.
- Checked page by page against the source, with its licence and the date we checked it shown here.
Questions about this document
Can I fill in 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) without printing it?
Yes. Open the PDF in any normal PDF reader, type into the fields, tick the boxes and save. You can still print it if you prefer.
Is this document up to date and legally valid?
Please check the document for currency and for the rules that apply to you. It is a blank template, not legal advice or a guarantee of compliance.
Can I try it before buying?
A free preview of the first page is available when previews are switched on.