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Certification of Health Care Provider for Employees Serious Health Condition under the Family and Medical Leave Act. S. Department of Labor Wage and Hour Division DO NOT SEND COMPLETED FORM TO THE

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What is fml-certification-family-member?

The FML Certification Family Member is a form that is used to certify the need for leave under the Family and Medical Leave Act (FMLA) for a family member's serious health condition.

Who is required to file fml-certification-family-member?

Employers are required to file the FML Certification Family Member when an employee requests FMLA leave to care for a family member.

How to fill out fml-certification-family-member?

To fill out the FML Certification Family Member form, provide information including your name, relationship to the family member, the medical condition, and the duration of the leave needed.

What is the purpose of fml-certification-family-member?

The purpose of the FML Certification Family Member is to verify the need for leave under the FMLA for caring for a family member with a serious health condition.

What information must be reported on fml-certification-family-member?

The form must include the employee's information, the family member's condition, the duration of the needed leave, and the healthcare provider's certification.

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