New FMLA Certification Forms Available

February 16, 2012 - by: Tammy Binford 3 COMMENTS

The U.S. Department of Labor (DOL) has released new certification forms for leave under the Family and Medical Leave Act (FMLA). The new forms carry an expiration date of February 28, 2015, and replace forms that had a December 31, 2011, expiration date.

The new forms appear to be identical to the old forms except for the expiration date. They don’t include the “safe harbor” language required by the Genetic Information Nondiscrimination Act (GINA), which informs employees that they shouldn’t provide any genetic information when responding to any employer request for medical information.

Employers are advised to include the safe harbor notice with requests for medical certification. The Equal Employment Opportunity Commission (EEOC) has suggested the following language:

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

The forms with the new expiration date are as follows: Certification of Health Care Provider for Employee’s Serious Health Condition; Certification of Health Care Provider for Family Member’s Serious Health Condition; Notice of Eligibility and Rights & Responsibilities; Designation Notice; Certification of Qualifying Exigency for Military Family Leave; and Certification for Serious Injury or Illness of Covered Servicemember – for Military Family Leave.

About Tammy Binford:
Tammy Binford writes and edits news alerts and newsletter articles on labor and employment law topics for BLR web and print publications. In addition, she writes for HR Hero Line and Diversity Insight, two of the ezines and blogs found on
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1 Celia H. Dominguez
08:50:30, 23/02/12

Where can I download these new forms?

Thank you,
Celia H. Dominguez
Town of Silver City
PO Box 1188
Silver City, NM 88062

2 Sharon McKnight
09:11:40, 07/03/12

You can find the FMLA forms with the new expiration date on HRHero on the forms page, which is listed under “HR Tools.” You’ll need to be logged-in to access the page. Hope this helps.

3 Frances Ash
06:09:01, 06/09/12

Please show us the new forms

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