An employer may request that military caregiver leave certification set forth the following information, which must be provided by the employee and/or veteran:

• The name and address of the employer of the employee requesting leave;
• The name of the employee requesting leave;
• The name of the veteran the employee is requesting leave to care for;
• The relationship of the employee to the veteran;
• The veteran’s date of separation from military service, and whether the separation was other than dishonorable (the employer may also require documentation issued by the military, which an employee may satisfy by providing a copy of the veteran’s Certificate of Release or Discharge from Active Duty (DD Form 214)); and,
• A description of the care to be provided to the veteran and an estimate of the leave needed to provide the care.

DOL has developed an optional form (WH-385-V) for an employee’s use in obtaining certification that meets these requirements. This optional form reflects certification requirements to permit the employee to furnish appropriate information to support his or her request for leave to care for a veteran with a serious injury or illness. The employer may use form WH-385-V, or another form containing the same basic information. However, no information may be required by an employer beyond that specified in the FMLA regulations. In all instances, the information on the form must relate only to the serious injury or illness for which the current need for leave exists.

An employee who has provided documentation indicating the servicemember’s enrollment in the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers may still be required to provide confirmation of covered family relationship to the servicemember and may also be required to provide documentation showing that the discharge was other than dishonorable and the date of the veteran’s discharge.

Continue to Military Caregiver Leave Certification – Authentication and Clarification or Return to Military Family Leave Certifications.