Employers can require this certification when an employee requests FMLA military caregiver leave, up to 26 weeks, to care for a current servicemember with a serious injury or illness. The servicemember's health care provider confirms the injury or illness was incurred or aggravated in the line of duty on active duty, that treatment is under way, and estimates the continuous, scheduled or intermittent care needed.
The employer or employee completes Section I and the employee or servicemember Section II; the servicemember's health care provider completes Section III, Parts A to C, as a DOD, VA, TRICARE network, non-network TRICARE or other FMLA health care provider.
Download the current version from the source each time; forms change without notice.
Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave under the Family and Medical Leave Act
Certificado de lesión o enfermedad grave de un miembro actual del servicio para la licencia de cuidador militar conforme a la Ley de Ausencia Familiar y Médica
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Section III can be completed by a DOD health care provider, a VA health care provider, a DOD TRICARE network or non-network authorized private provider, or another health care provider as defined in 29 C.F.R. 825.125. The provider limits answers to the servicemember's condition and leaves out genetic information.
Yes. The Department of Labor's Wage and Hour Division posts English and Spanish versions of WH-385, revised June 2020, under OMB control number 1235-0003. Veterans are covered by a separate form, WH-385-V, which asks different questions about the veteran's discharge and condition.