Guide to the New Optional FMLA Forms

Effective June 2020, the U.S. Department of Labor (DOL) updated certain optional Family and Medical Leave Act (FMLA) forms. The DOL does not require the use of any specific forms or format and in fact, employers may use their own forms. However, the optional forms are simpler and easier for employees, employers, leave administrators and health care providers to understand and use. 

Notice of Eligibility and Rights and Responsibilities

  1. The old version had a list of employee responsibilities and a list of employee rights. The new notice relates to an employee’s FMLA leave and return to work.
  2. The DOL requires that employees work at least 1,250 hours during the 12 months prior to the start of the leave. The new form requires employers to indicate the number of hours that fall short of the required hours. 
  3. The new form provides an option for an employer to indicate the effect that FMLA leave has on employee benefits other than health insurance.
  4. The new form states whether FMLA leave will run concurrently with workers’ compensation, any applicable disability insurance coverage, or leave required by state law.
  5. The new form states each time an employee takes FMLA leave, the remaining leave is the balance of the 12 weeks not used during the 12 months immediately before the FMLA leave is to start. This is not a new requirement however as a point of clarity, it should be noted this statement applies to continuous leave and does not apply to intermittent leave. Tracking time as intermittent leave is measured from each day the leave is used.

Designation Notice

The primary change to this form is the requirement employees must take to explain missing and/or insufficient information to expedite decision-making.  

Medical Certifications

The revised health care provider certification for an employee’s own serious health condition or a family member’s condition now requires the health care provider to provide a “best estimate” of the employee’s or family member’s future treatment thus minimizing the need for repeated doctor follow-up. 

Additional Resources

For more information on the new FMLA forms, visit:

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