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Designation Notice (Family and Medical Leave Act) U.S. Department of Labor Wage and Hour Division OMB Control Number: 1235-0003 Expires: 2/28/2015 Leave covered under the Family and Medical Leave
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How to fill out wh 382 form
How to fill out WH 382:
01
Obtain the WH 382 form, which is the Certification of Qualifying Exigency for Military Family Leave.
02
Fill out the employee's name, employee identification number, mailing address, telephone number, and email address in the respective fields.
03
Specify the employee's relationship to the military member for whom the leave is being requested.
04
Indicate the name, rank, and branch of service of the military member.
05
Provide a brief description of the qualifying exigency for which the leave is being requested.
06
Fill out the anticipated beginning and end dates of the qualifying exigency.
07
Attach any supporting documentation required to substantiate the need for leave.
08
Sign and date the form.
Who needs WH 382:
01
Employees who have a qualifying exigency relating to their military family member's active duty or impending call to active duty.
02
Employers who must verify and approve the employee's request for leave based on the qualifying exigency.
Video instructions and help with filling out and completing wh 382
Instructions and Help about fillable wh 382 form
Welcome to module 2 in this module we×39;prereviewing the forms provided by department of Labor for Family MedicalLeave situations the form we have Paris the final form that a supervisor gives to an employee to indicate to that employee whether they're leave is considered covered under the FamilyMedical Leave Act this form is called the designation notice it's also referred to as form WH 382 so let×39’s walkthrough this form as you can see it asks you to give the employees name and the date that you×39’re completing the form and then it indicates here we reviewed your request for leave under the FamilyMedical Leave Act we×39’ve received your most recent information on and decided, and then it indicates here your family medical leave request is approved if foursome reason the documentation received from the doctor is not sufficient please contact human resources and will help you to navigate that process if you have received all the appropriate documentation you certainly can checkoff your family medical leave request disapproved as long as the employee ineligible for Family Medical Leave instates here that Family Medical Leave requires that you notify us as soon as practicable if the dates of your scheduled leave our extended or they×39’re unknown to get in touch with the employer and let him or her know exactly what belief situation is, so it indicates here that if you do have an idea of the amount of time that you check off provided their×39’s no deviation from your anticipated schedule the following number of hours days a week will recount against your leave entitlements if the employee has told you I need12 weeks starting on this date you certainly can indicate the dates that will be covered by Family MedicalLeave if the leave is an emergency leave, and you're not sure how long the employee will be off you certainly want to check off because the leave you will need will be unscheduled it×39’s not possible to provide the hours days or weeks that will be counted against your family medical leave entitlement at this time and of course the employee can request that once he or she×39’s gotten the information needed to the supervisor about the length of the leave then it indicates here please be advised check if applicable we are not indicating hardhat vacation leave has to be paid output we do require sick leave to be paid out so if an employee is taking leave for Family Medical Leave purposes either for his or her own medical condition onto care for a family member we may very well require that they use sick leave, so you certainly can indicate here we are requiring you to substitute or use paid leave during your family medical leaves you do want to indicate that since we'd require that sick leave be paid trout to an employee on leave in some instances an employee may not be eligible to use his or her and sick leave when caring for a family member, so you would want to call human resource sand check into that before indicating you×39’re not sure...
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Who is required to file wh 382 form?
The WH-382 form is used by employers to certify that an employee is entitled to take unpaid family and medical leave under the Family and Medical Leave Act (FMLA). The form must be completed by an employee’s employer, and the employee must provide a copy of the form to the employee.
What is the purpose of wh 382 form?
The WH-382 form is used by employers to certify that an employee is entitled to take unpaid leave under the Family and Medical Leave Act (FMLA). This form includes the employee's name, the dates of the leave, and the reason for the leave. It is signed by the employer and the employee and is used to ensure compliance with the FMLA.
What information must be reported on wh 382 form?
The WH-382 form must include the following information:
1. Employer name, address, and contact information
2. Employer Identification Number (EIN)
3. Employee name, Social Security Number, and address
4. Date of injury
5. Description of the injury or illness
6. Type of injury or illness
7. Date of first medical treatment
8. Date of initial return to work
9. Date of final medical treatment
10. Total days of disability
11. Description of any job restrictions or accommodations required due to the injury or illness
12. Any medical expenses paid by the employer
13. Any workers' compensation benefits paid by the employer
14. Signature of employer's representative
When is the deadline to file wh 382 form in 2023?
The deadline to file WH-382 form in 2023 is October 15th.
What is the penalty for the late filing of wh 382 form?
The penalty for late filing of Form WH-382 is a minimum of $25 and a maximum of $110 per employee per violation.
What is wh 382 form?
The WH-382 form is a certification of qualifying exigency for military family leave. It is used by an employee to provide documentation to their employer in order to take leave under the Family and Medical Leave Act (FMLA) for certain qualifying reasons related to a family member's military service.
How to fill out wh 382 form?
To correctly fill out the WH-382 form, you can follow these steps:
1. Download the WH-382 form from the official website of the Department of Labor or obtain a physical copy from your employer.
2. Begin by entering the name of the employee who is requesting leave on the "Employee Name" field.
3. In the "Employee's Last Day Worked" field, fill in the last day your employee worked before taking leave.
4. Next, fill in the "Employee's First Day Not Worked" field with the first day the employee did not work due to the leave.
5. Enter the return-to-work date in the "Employee's Expected Return to Work Date" field.
6. In the "Intermittent or Reduced Leave Schedule" section, indicate whether the employee will be taking continuous leave or if it will be intermittent or on a reduced schedule.
7. If the leave is intermittent or on a reduced schedule, specify the anticipated frequency and duration of absences in the corresponding fields.
8. Have the employee sign and date the form in the "Employee's Signature" and "Date" fields.
9. Once the employee has signed, provide the "Notice to Employee" section to the employee for their records. Fill in the "Received By" section with the name of the person receiving the notice.
10. The employer or authorized representative should also sign and date the form in the "Employer/Authorized Representative's Signature" and "Date" fields.
11. Keep a copy of the completed form for the employer's records and provide a copy to the employee.
12. Ensure that all required fields are filled out correctly and accurately before submitting the form.
Note: It is essential to consult the latest version of the WH-382 form and refer to the official instructions provided by the Department of Labor to ensure compliance with any updates or changes.
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