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

• The name and address of the employer of the employee requesting leave;
• The name of the employee requesting leave;
• The name of the servicemember the employee is requesting leave to care for;
• The relationship of the employee to the servicemember;
• Whether the servicemember is a current member of the Armed Forces, the National Guard or Reserves, and his or her military branch, rank and current unit assignment;
• Whether the servicemember is assigned to a military medical facility as an outpatient or to a unit established for the purpose of providing command and control of members of the Armed Forces receiving medical care as outpatients, such as a medical hold or warrior transition unit, and the name of the medical treatment facility or unit;
• Whether the servicemember is on the temporary disability retired list; and,
• A description of the care to be provided to the servicemember and an estimate of the leave needed to provide the care.

DOL has developed an optional form (WH-385) 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 covered servicemember with a serious injury or illness. The employee may use form WH-385, 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.

In some circumstances, an employee may use an invitational travel order or authorization in lieu of certification.

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