Family and Medical Leave Act
(FMLA) Forms

05/02/2012 - The APWU FMLA Forms are once again available for employees to use when submitting medical certification for leave under the Family & Medical Leave Act (FMLA). In accordance with an April 18, 2012, award by Arbitrator Shyam Das, the Postal Service cannot require employees to use the Department of Labor’s WH-380 forms. Arbitrator Das recognized that the DOL Forms are optional forms. The USPS must accept an employee’s medical certification in any format — provided it contains all of the information required under the law.

The APWU notes that the DOL WH-380 forms created in 2009 solicit information from healthcare providers beyond what is actually required under the law. For example, the WH-380-E and WH-380-F Forms invite healthcare providers to state the medical diagnosis. The APWU has consistently asserted, and the Postal Service has agreed, that the medical diagnosis/prognosis is private health information that is not required on the form.

Although the APWU forms may look different than the DOL forms, the APWU forms reflect the same basic FMLA medical certification requirements so as to permit healthcare providers to furnish appropriate medical information in accordance with the law.

The APWU forms are more streamlined, easier for healthcare providers to use, and protect against inappropriate disclosure of protected health information. For these reasons, the APWU encourages union members to use FMLA medical certification forms developed by the APWU.

Please keep in mind that, regardless of what format an employee uses for FMLA medical certification, if a medical certification is incomplete or insufficient, the Postal Service is required to explain to the employee in writing what specific, additional information is necessary to make the certification complete and sufficient and give the employee an opportunity to cure the defects.

We are continuing to discuss implementation of the Das award with the Postal Service. We expect that management will soon update ELM 515 to bring it into compliance. Please check this Web site periodically for updated information.

 

Certification by a Health Care Provider for the Employee’s Own Serious Illness:

Certification by a Health Care Provider for a Family Member’s serious Illness:

Certification by Employee of Qualifying Exigency for Military Family Leave:

Certification by a Service Member’s Health Care Provider for Caregiver Military Family Leave:

Sample Completed APWU Forms

Sample Form for Employee's Absence Plus Treatment

Sample Form for Child with Chronic Condition

Sample Form for Chronic Condition

Sample Form for Hospital Stay

Sample Form for Long Term-Terminal Illness

Sample Form for Multiple Treatments

Sample Form for Pregnancy