Fill Out DOL Form WH-381 Online
Notice of Eligibility and Rights & Responsibilities (FMLA)
U.S. Department of Labor
Notifies an employee of FMLA eligibility and explains their rights and responsibilities.
Reviewed July 2026
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Form WH-381, the Notice of Eligibility and Rights and Responsibilities, is the Department of Labor's model notice that employers use to respond to an FMLA leave request. It tells the employee whether they are eligible for FMLA leave and spells out their obligations, such as providing medical certification.
HR teams can fill out the WH-381 in the Universal PDF editor, check the eligibility boxes that apply, and download a completed PDF to deliver to the employee and file in the FMLA record.
What is Form WH-381 used for
When an employee requests leave that may be covered by the FMLA, the employer must promptly notify the employee whether they are eligible. The WH-381 combines that eligibility notice with the required rights-and-responsibilities notice, covering items like certification requirements, substitution of paid leave, health insurance premium payments during leave, and job restoration rights.
If the employee is not eligible, the form requires the employer to state at least one reason, for example not having worked the required hours in the previous 12 months.
Who files Form WH-381
The employer completes and delivers the WH-381. It applies to FMLA-covered employers, which generally means private employers with 50 or more employees, public agencies, and public and private elementary and secondary schools.
Eligibility for the employee side generally requires 12 months of employment with the employer, at least 1,250 hours worked in the previous 12 months, and a worksite where the employer has 50 or more employees within 75 miles.
How to fill out Form WH-381
The form is mostly checkboxes and short fields:
- Identify the employee, the date of the leave request, and the qualifying reason.
- Check whether the employee is eligible; if not, mark the specific reason for ineligibility.
- Complete the rights and responsibilities section, including whether medical certification is required and whether paid leave will be substituted.
- State how much FMLA leave entitlement the employee has available if known, and deliver the notice to the employee.
Deadlines and retention rules
The FMLA regulations require the employer to provide the eligibility notice within five business days of the employee's leave request, or within five business days of learning that a leave may be for an FMLA-qualifying reason, absent extenuating circumstances.
The notice can be delivered on paper or electronically. Like other FMLA paperwork, a copy stays in the employer's records for at least three years; nothing is filed with the Department of Labor.
Frequently asked questions
Within five business days of the employee requesting leave, or of the employer learning that a leave may be FMLA-qualifying, absent extenuating circumstances.
The WH-381 is an optional model form. Employers can use their own notice as long as it includes all the eligibility and rights-and-responsibilities information the regulations require.
Generally an employee with 12 months of service, at least 1,250 hours worked in the previous 12 months, and a worksite where the employer has 50 or more employees within 75 miles.
The WH-381 tells the employee whether they are eligible for FMLA leave and explains their responsibilities. The WH-382 comes later and tells the employee whether the specific leave is designated as FMLA leave.
No. The employer gives it to the employee and keeps a copy in its own FMLA records.
Related forms
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