DOL WH-385-V 2015 free printable template

Certification for Serious Injury U.S. Department of Labor or Illness of a Veteran for Wage and Hour Division Military Caregiver Leave (Family and Medical Leave Act) DO NOT SEND COMPLETED FORM TO THE

How to fill out DOL WH-385-V

How to fill out DOL WH-385-V

1. Begin by filling out your name and contact information at the top of the form.
2. Indicate the name and contact information of the employer.
3. Specify the employee's name and relation to the individual requiring care.
4. Provide a detailed description of the medical condition of the individual needing care.
5. Indicate the expected duration of the care needed.
6. Include any additional relevant medical information that may be required by the employer.
7. Sign and date the form for validation.

Who needs DOL WH-385-V?

1. Employees who are seeking leave to care for a family member with a serious health condition may need to fill out DOL WH-385-V.
2. Individuals who wish to provide documentation to support their request for family leave benefits under the Family and Medical Leave Act (FMLA).

People Also Ask about

What is FMLA and how does it work?

The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave.

How many bereavement days are you entitled to in AZ?

Bereavement Leave is an administrative leave/absence that provides fully benefits-eligible employees, who are in a paid status, 3 paid working days off for a death in the family.

What's the difference between PFL and FMLA?

What is the difference between FMLA and PFL? FMLA is a federal law defining employee rights required of some employers to provide unpaid medical leave. PFL policies are state-paid regulations that vary from state to state and supersede federal law when the benefits are more generous than the national regulation, FMLA.

How does PFL and FMLA work together?

FMLA and PFL Concurrent FMLA will run concurrently if the PFL reason and family member also qualifies for FMLA PFL will run concurrently if the FMLA reason and family member also qualifies for PFL, even if the employee chooses not to apply for the paid PFL.

What is considered immediate family in Arizona?

Spouse, parent (as defined above), father, mother, brother, sister, brother-in-law, son-in-law, sister-in-law, daughter-in-law. Child—defined as: natural, adopted, foster, step-child or grand-child.

What qualifies for FMLA in Arizona?

To take the leave, you must have recently given birth or adopted a child, have a serious health condition, including pregnancy-related health conditions or incapacities, or be taking care of a family member with a serious health condition.

How is FMLA entitlement calculated?

CALCULATION OF LEAVE USAGE The amount of FMLA leave taken is divided by the number of hours the employee would have worked if the employee had not taken leave of any kind (including FMLA leave) to determine the proportion of the FMLA workweek used.

Do you get paid for FMLA leave in AZ?

FMLA time off is unpaid. However, if the employer offers some paid time off, such as vacation pay, employers can require employees on FMLA to use this paid time off while on FMLA.

How long do PFL benefits last?

How long can I receive PFL benefits? You may receive PFL benefits for up to 8 weeks within any 12-month period for care, bonding, or military assist claims. You can break up your eight weeks. You don't have to take PFL all at once.

Is FMLA paid?

FMLA leave is unpaid leave. However, workers may choose to, or employers may require them to, substitute accrued paid sick, vacation, or personal time for FMLA leave. Substitute means that the paid leave provided by the employer will run concurrently with the unpaid FMLA leave.

What are the qualifications for FMLA in Arizona?

Employees are eligible to take FMLA leave if they work for a covered employer and: Have worked for their employer for at least 12 months. Have at least 1,250 hours of service over the previous 12 months. AND work at a location where at least 50 employees are employed by the employer within 75 miles.

How much does FMLA pay in PA?

Under the FMLA, your job is protected for 12 weeks. But you do not get paid. Sick leave is a welcome addition to FMLA leave. Everyone gets sick from time to time.

What are the rules around FMLA?

In order to be eligible to take leave under the FMLA, an employee must (1) work for a covered employer, (2) work 1,250 hours during the 12 months prior to the start of leave, (3) work at a location where 50 or more employees work at that location or within 75 miles of it, and (4) have worked for the employer for 12

What are PFL benefits?

Paid Family Leave (PFL) provides benefit payments to people who need to take time off work to: Care for a seriously ill family member. Bond with a new child. Participate in a qualifying event because of a family member's military deployment.

Who is eligible for FMLA in South Dakota?

Employees are eligible if they have worked for a covered employer for at least one year, and for 1,250 hours over the previous 12 months, and if there are at least 50 employees within 75 miles.

Does Pennsylvania have Family leave?

Employers Covered In addition to the federal FMLA, Pennsylvania has leave laws regarding pregnancy and childrearing or child care (contained in the Pennsylvania Human Relations Act and regulations issued by the Pennsylvania Human Relations Commission). Employers with four or more employees.

Is PFL separate from FMLA?

Paid sick leave, FMLA leave, and paid family and medical leave are all types of paid or unpaid time off from work, but they are distinct policies and, where enacted, laws.

Can you collect unemployment on FMLA in PA?

Generally no, you are not eligible for unemployment benefits if you take medical leave under the Family and Medical Leave Act and you cannot work. 2.

What does FMLA cover in PA?

Employees in Pennsylvania may take up to 12 weeks of leave in a 12-month period for a serious health condition, bonding with a new child, or qualifying exigencies. This leave renews every 12 months, as long as the employee continues to meet the eligibility requirements set out above.

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What is DOL WH-385-V?

DOL WH-385-V is the U.S. Department of Labor's form used to request certification for leave under the Family and Medical Leave Act (FMLA) for a serious health condition of a family member.

Who is required to file DOL WH-385-V?

Employees who plan to take FMLA leave to care for a family member with a serious health condition are required to file DOL WH-385-V.

How to fill out DOL WH-385-V?

To fill out DOL WH-385-V, provide the employee's information, the family member's details, the health condition, and the healthcare provider's information, then sign and date the form.

What is the purpose of DOL WH-385-V?

The purpose of DOL WH-385-V is to document the need for FMLA leave due to a family member's serious health condition and to provide the employer with necessary medical information.

What information must be reported on DOL WH-385-V?

The form requires information about the employee, the family member's health condition, details about the medical provider, and signatures from both the employee and healthcare provider.