How to Complete An FMLA Form For A Family Member

FMLA forms for family members
When faced with a serious illness or injury, it can be very difficult to know what steps to take to ensure you are well taken care of and adequate communication is relayed to your employer. To that , it can often be even more difficult to properly understand which avenues to take when dealing with a family member who has suffered health issues.

The U.S. Department of Labor has provided employees with the WH-380-F Form, which allows for a caretaker of an ill or injured family member to file for FMLA benefits.

In order to qualify for FMLA benefits, employees must be aware of the eligibility requirements prior to filing, which are as follows:

  • The employee must have worked a minimum of 1,250 hours within a 12 month employment period and worked 12 consecutive months.
  • The employer must be located within the U.S.
  • The employer must have a minimum of 50 employees that work within 75 miles of the work site.

If filing for a family member, be sure you have this information readily available.

Once you have reviewed the requirements with your family member and established their eligibility, be sure to contact the U.S. Department of Labor online, phone, or by simply visiting a local office and obtain Form WH-380-F. In completing this form, the involvement of the healthcare provider, as well as the employer, is required. It is the responsibility of the caretaker to provide any information requested of the family member that is incapacitated and incapable of completing the form.

Prior to submitting the completed FMLA form, be sure to review for accuracy to ensure the employer has all of the requested and required information to accept the employee’s request for benefits. All employees are generally entitled to the following once their request has been approved:

  • 12 workweeks of leave in a 12 month period
  • The birth of a child and to care for the child within 1 year of birth
  • In placement and care of a child for adoption or foster care within 1 year of placement
  • The care of a spouse, child, or parent with a serious illness or injury
  • A serious health condition that makes the employee incapable of performing required job functions
  • An employee’s spouse, child, or parent who is on “covered active duty” and must meet qualifying requirements
  • Or 26 workweeks of leave in a single 12 month period to care for a covered service member with a serious illness or injury if the employee is the spouse, child, parent or next of kin (military caregiver leave).

For further references pertaining to FMLA requirements and forms, please visit the following websites:

FMLA Forms

FMLA Compliance

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