Six free FMLA designation notice templates covering every decision you can reach: approval, conditional pending certification, denial, intermittent leave, fitness-for-duty with an essential-functions list, and the change-of-designation notice almost nobody has on file. Editable DOCX, no signup.
The FMLA designation notice is the document that tells an employee whether their leave counts as FMLA leave and how much of their entitlement it will consume. Federal Form WH-382 is the official version, and using it is optional. Sending the notice is not. The deadline is five business days from the point you have enough information to decide, which is usually the day a complete certification lands on your desk rather than the day the employee first asked for time off.
These six templates cover every decision you can actually reach, not just the easy one. Approval, conditional while a certification is being fixed, denial or exhausted entitlement, intermittent leave where the hours are unknown, designation with a fitness-for-duty requirement and an essential-functions list, and the change-of-designation notice for when the facts move mid-leave. Each downloads as an editable Word document, free and without an email.
TL;DR
An FMLA designation notice tells an employee whether leave is designated as FMLA and how much counts against their entitlement. It must be written and sent within five business days of having enough information to decide. Form WH-382 is optional; your own compliant version is fine. Flag any fitness-for-duty requirement here or you generally cannot add it later. Six free DOCX templates below. This is general information, not legal advice.
What a Designation Notice Is
A designation notice is the employer's written decision on a leave request: designated as FMLA, or not, plus the amount that will count against the employee's 12-week entitlement. It comes after the eligibility and rights-and-responsibilities notice and after any certification, and it is the last of the three notices in a normal FMLA sequence.
The responsibility sits entirely with the employer. Once an eligible employee communicates a need for leave for a qualifying reason, the employer may not delay designating it, and neither the employee nor the employer may decline FMLA protection for that leave. An employee cannot save their entitlement by asking you to treat qualifying time as ordinary paid time off instead.
Verbal Designation Does Not Count
The designation notice must be in writing. A manager telling someone their leave is approved is not a designation, and a note in a scheduling system is not one either. The one narrow exception runs the other way: where leave is not designated because it does not meet the requirements of the Act, the notice may take the form of a simple written statement (29 CFR 825.300(d)). Short is allowed. Unwritten is not. This is general information, not legal advice.
What It Must Include
Four groups of information belong in a complete designation notice: the decision, the count, the conditions that apply during the leave, and the return-to-work terms. Miss any of them and the notice is defective even if it was sent on time.
The decision
Designated as FMLA, or not
Written form, always
One notice per qualifying reason
The count
Hours, days, or weeks counted
Your 12-month leave year
Balance on request if unknown
Conditions during leave
Paid leave substitution
Whether paid leave runs concurrently
Premium payment arrangement
Return to work
Fitness-for-duty required or not
Essential-functions list if required
What is still missing, if anything
The element most often left blank is the count. If you know how much leave is involved, you have to state the number of hours, days, or weeks that will be charged against the entitlement. If you genuinely cannot know, as with unforeseeable intermittent leave, you must give the figure on request instead, no more than once in a 30-day period and only if leave was taken in that period, confirming any verbal figure in writing by the following payday.
Which Template to Use?
Pick by the decision you actually reached, not by what you hope the answer will be. Most leaves take the approval version. The conditional version exists because a shaky certification is not a denial, and the change notice exists because designations go stale.
Approval Designation Notice
The default
The full notice for approved leave: the decision, the exact amount counted against the entitlement, the leave year you use, paid-leave substitution, benefit terms, and delivery record. Start here for most leaves.
Conditional / Pending Certification
Additional information needed
For when a certification arrives incomplete or insufficient. Names the specific missing or unclear entries, sets the cure deadline, and states what happens either way. Neither an approval nor a denial.
Not Designated as FMLA
Denial or exhausted
For leave that does not qualify, an employee who is not eligible, a missed certification deadline, or an exhausted entitlement. Says plainly what happens to the absence instead.
Intermittent / Reduced Schedule
Hours not known in advance
The version for episodic absences, where the hours cannot be stated up front. Covers the counting increment, the once-per-30-days balance request, call-in steps, and recertification.
With Fitness-for-Duty Requirement
Plus essential functions
Designation plus the return-to-work certification requirement and an attached essential-functions list. The requirement generally cannot be added later if it is not flagged here.
Change of Designation Notice
When the facts move
The follow-up almost nobody has on file: a short written update when the entitlement runs out mid-leave, the dates move, or the amount counted changes.
Match the Template to the Decision
Leave qualifies and you have the facts: Approval. Certification arrived blank or unclear: Conditional. Reason does not qualify, employee is not eligible, or entitlement is gone: Not Designated. Episodic absences with no fixed hours: Intermittent. You want a return-to-work certification: Fitness-for-Duty, with the essential-functions list attached. Something in an earlier notice has changed: Change of Designation. When both a state law and the FMLA apply, see the state overlay section before sending.
6 Free FMLA Designation Notice Templates
Download all six together or copy an individual notice. Each one is a plain-language, fill-in-the-blank equivalent of the federal form, restructured so you are not hunting through checkboxes that do not apply to your situation. Fill in your leave-year definition, the amount counted, and your contact details before sending.
Download All 6 Designation Notice Templates
Approval, conditional, denial, intermittent, fitness-for-duty, and change of designation. Six DOCX files in one download.
Template 1: FMLA Designation Notice (Approval)
The full notice for approved leave: the decision, the exact amount counted against the entitlement, the leave year you use, paid-leave substitution, benefit terms, and a delivery record. The version most leaves need.
FMLA Designation Notice (Approval)
DESIGNATION NOTICE UNDER THE FAMILY AND MEDICAL LEAVE ACT
[Company Name]
[Company Address]
To: [Employee Name] Date: [mm/dd/yyyy]
From: [Name, Title]
We received the most recent information supporting your need for leave on
[mm/dd/yyyy].
1. DECISION
Your leave request is APPROVED. All leave taken for this reason will be
designated as FMLA leave and counted against your FMLA entitlement.
Qualifying reason (select one):
•The birth of a child, or placement of a child with you for adoption or foster
care, and to bond with that child
•Your own serious health condition
•The serious health condition of your [spouse / child / parent]
•A qualifying exigency arising from covered active duty of a family member
•Care for a covered servicemember with a serious injury or illness
Approved leave dates: [start date] through [end date]
Amount that will count against your FMLA entitlement:
[number] [hours / days / weeks]
Our 12-month FMLA leave year is measured as: [calendar year / fixed year
beginning ___ / 12 months forward from first use / rolling 12 months measured
backward].
Remaining entitlement after this leave, as of today: [number] [hours / days /
weeks].
Please notify us as soon as practicable if your leave dates change, are
extended, or were initially unknown.
3. PAID LEAVE AND BENEFITS DURING LEAVE
•Paid leave substitution: You [are required to / may elect to / are not
required to] use accrued [PTO / vacation / sick leave] during this FMLA
leave. Any such paid leave will run concurrently with, and count against,
your FMLA entitlement.
•Group health coverage continues on the same terms during FMLA leave. Your
share of the premium is $[amount] per [pay period], due [date / arrangement].
•Contact for questions during your leave: [Name, title, phone, email].
4. RETURN TO WORK
[ ] You are NOT required to provide a fitness-for-duty certification.
[ ] You ARE required to provide a fitness-for-duty certification before
returning to work. (If checked, complete the fitness-for-duty version of
this notice and attach the list of essential functions.)
Expected return-to-work date: [mm/dd/yyyy]
5. ACKNOWLEDGMENT
Delivered to the employee by: [ ] hand [ ] email [ ] mail to address of
record, on [mm/dd/yyyy] by [Name].
Employee signature (receipt only, not agreement): __
Date: _
Employer signature: __ Date: _
DISCLAIMER: This is a sample template for general information only and is not
legal advice. Use of the federal model form is optional, but the written
designation notice itself is required and must be provided within five business
days of having enough information to decide, absent extenuating circumstances.
State leave laws may add requirements. Have a qualified employment attorney
review before use.
Template 2: Conditional Designation Notice
For a certification that arrived incomplete or insufficient. Names the specific missing entries or unclear answers, sets the seven-day cure deadline, and states what happens either way. This is not a denial.
Conditional Designation Notice (Certification Incomplete or Insufficient)
DESIGNATION NOTICE: ADDITIONAL INFORMATION NEEDED
[Company Name]
To: [Employee Name] Date: [mm/dd/yyyy]
From: [Name, Title]
We received your certification on [mm/dd/yyyy]. We cannot yet determine whether
your leave qualifies under the FMLA because the certification is incomplete or
insufficient. This notice tells you exactly what is missing and how long you
have to fix it.
1. WHAT IS WRONG WITH THE CERTIFICATION
[ ] INCOMPLETE. One or more required entries were left blank.
The following entries are blank: [list each item and page or question
number].
[ ] INSUFFICIENT. The information provided is vague, ambiguous, or
non-responsive.
The following answers are unclear and why: [list each item and explain what
is unclear].
2. WHAT WE NEED FROM YOU
Provide the specific information listed above. You must return the corrected or
completed certification by [date, at least seven calendar days from the date of
this notice].
If the deficiency cannot practicably be cured in seven calendar days despite
your diligent, good faith efforts, tell us in writing before the deadline and
we will discuss additional time.
3. WHAT HAPPENS NEXT
•If we receive complete and sufficient information, we will tell you within
five business days whether your leave is designated as FMLA leave.
•If we do not receive it, your leave may be denied FMLA protection and your
absences may be treated under our regular attendance policy.
4. IN THE MEANTIME
Your leave status during this period: [approved provisionally / unpaid,
undesignated / other]. This notice is not a denial and is not a designation.
Contact with questions: [Name, title, phone, email].
Delivered by: [ ] hand [ ] email [ ] mail, on [mm/dd/yyyy] by [Name].
Employer signature: __ Date: _
DISCLAIMER: This is a sample template for general information only and is not
legal advice. Where a certification is incomplete or insufficient, the employer
must state in writing what additional information is needed and generally give
the employee seven calendar days to cure. Have a qualified employment attorney
review before use.
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For a non-qualifying reason, an ineligible employee, a missed certification deadline, or an exhausted entitlement. Says plainly how the absence will be handled instead, and points to leave that may still apply.
Designation Notice (Leave Not Designated as FMLA)
DESIGNATION NOTICE: LEAVE NOT DESIGNATED AS FMLA
[Company Name]
To: [Employee Name] Date: [mm/dd/yyyy]
From: [Name, Title]
We have reviewed the information you provided about your leave beginning
[mm/dd/yyyy]. Your leave is NOT designated as FMLA leave and is not
FMLA-protected.
1. REASON
Select the reason that applies:
[ ] The reason for your leave is not covered by the FMLA.
Explanation: [state plainly why, for example: the family relationship is
not one the FMLA covers, or the condition does not meet the definition of a
serious health condition].
[ ] You have exhausted your FMLA leave entitlement for the applicable 12-month
period. Your entitlement was [12 / 26] weeks and you have used [amount]. As
of [date], you have no FMLA leave available.
[ ] We did not receive a complete and sufficient certification by the deadline
of [date] stated in our notice of [date].
[ ] You are not an eligible employee. Reason: [months of service / hours of
service / worksite headcount within 75 miles].
2. WHAT THIS MEANS
Your absence will be handled under our regular [attendance / leave of absence /
paid time off] policy rather than the FMLA. This means [state the practical
consequence: whether the absence is paid, whether it is counted under the
attendance policy, and what approval is required].
3. OTHER LEAVE THAT MAY STILL APPLY
Even though the FMLA does not apply, you may still be entitled to leave or an
accommodation under other law or our own policies, including [state paid sick
leave / state family leave / disability accommodation / company leave of
absence policy]. Contact [Name] to discuss options.
4. QUESTIONS
Contact: [Name, title, phone, email].
Delivered by: [ ] hand [ ] email [ ] mail, on [mm/dd/yyyy] by [Name].
Employer signature: __ Date: _
DISCLAIMER: This is a sample template for general information only and is not
legal advice. A decision not to designate leave as FMLA must still be
communicated to the employee in writing, and other federal, state, or local
leave and accommodation obligations may apply independently. Have a qualified
employment attorney review before use.
Template 4: Intermittent or Reduced-Schedule Designation
For episodic absences where the hours cannot be stated up front. Covers the counting increment, the once-per-30-days balance request, call-in procedures, temporary transfer, and recertification.
Designation Notice for Intermittent or Reduced-Schedule Leave
DESIGNATION NOTICE: INTERMITTENT OR REDUCED-SCHEDULE FMLA LEAVE
[Company Name]
To: [Employee Name] Date: [mm/dd/yyyy]
From: [Name, Title]
Your request for intermittent or reduced-schedule leave is APPROVED and
designated as FMLA leave.
1. WHAT IS APPROVED
Leave type: [ ] Intermittent (episodic absences)
[ ] Reduced schedule (fewer hours per day or week)
Certified frequency and duration, per the medical certification:
Approximately [number] episodes per [week / month], lasting approximately
[number] [hours / days] each, expected through [date].
Reduced schedule, if applicable: [days and hours the employee will work].
Only one designation notice is required for this qualifying reason during the
applicable 12-month period, whether the leave is taken continuously or
intermittently.
2. HOW MUCH WILL COUNT AGAINST YOUR ENTITLEMENT
Because the timing of intermittent leave is not known in advance, we cannot
state the exact number of hours now. FMLA time will be counted in [minimum
increment used for other forms of leave, for example: 15-minute / 30-minute /
1-hour] increments, matching the smallest increment we use for other leave.
You may ask us at any time how much FMLA leave you have used. We will provide
that figure on request, but no more than once in a 30-day period, and only if
leave was taken in that period. If we give you the figure verbally, we will
confirm it in writing no later than the following payday.
Your remaining entitlement as of [date]: [number] hours.
3. CALLING IN
When you need to use intermittent FMLA leave, notify [Name / method] by [time
or notice window], and state that the absence is for your approved FMLA reason.
You do not need to give a medical explanation each time, but you must follow
Template 5: Designation with Fitness-for-Duty Requirement
Designation plus the return-to-work certification requirement and an attached essential-functions list, with the confidentiality and cost terms spelled out. Pair it with a return-to-work form when the employee comes back.
Designation Notice with Fitness-for-Duty Requirement
DESIGNATION NOTICE WITH FITNESS-FOR-DUTY REQUIREMENT
[Company Name]
To: [Employee Name] Date: [mm/dd/yyyy]
From: [Name, Title]
Your leave is designated as FMLA leave. This notice also tells you that a
fitness-for-duty certification is required before you return to work. We are
telling you now because a fitness-for-duty certification generally cannot be
required later if it was not flagged in the designation notice.
1. DESIGNATION AND COUNT
Approved dates: [start] through [end]
Amount counted against your FMLA entitlement: [number] [hours / days / weeks]
Remaining entitlement as of [date]: [number]
2. FITNESS-FOR-DUTY CERTIFICATION REQUIRED
Before returning to work you must provide a certification from your health care
provider stating that you are able to resume work. This requirement applies
only to the health condition that caused this leave.
[ ] The certification must simply state that you are able to return to work.
[ ] The certification must specifically address your ability to perform the
essential functions of your position. The list of essential functions for
the position of [job title] is attached to this notice, and the
certification must address those functions.
Return this certification to [Name] by [date / on or before your first day
back].
3. ATTACHMENT: ESSENTIAL FUNCTIONS OF THE POSITION
Position: [Job Title] Department: [Department]
Essential functions:
•[Function 1: the task, how often, and any physical or cognitive requirement]
•[Function 2]
•[Function 3]
•[Function 4]
•[Function 5]
Physical and environmental requirements: [lifting weight and frequency,
standing or sitting duration, driving, exposure conditions, equipment used].
We may delay your return to work until the certification is provided. If you
neither provide it nor request additional FMLA leave, reinstatement rights
under the FMLA may end.
5. COST AND CONFIDENTIALITY
Any cost of obtaining the certification is yours; we do not pay for the visit
unless required by other law or our policy. Medical information will be kept
confidential and stored separately from your personnel file.
Delivered by: [ ] hand [ ] email [ ] mail, on [mm/dd/yyyy] by [Name].
Employer signature: __ Date: _
DISCLAIMER: This is a sample template for general information only and is not
legal advice. Fitness-for-duty requirements interact with the FMLA, the ADA,
workers compensation, and state law. Have a qualified employment attorney
review before use.
Template 6: Change of Designation Notice
The short written update for when the entitlement runs out mid-leave, the dates move, the amount counted changes, or the paid-leave arrangement shifts. Almost no employer has one of these on file until they need it.
Change of Designation Notice
NOTICE OF CHANGE TO A PREVIOUS FMLA DESIGNATION NOTICE
[Company Name]
To: [Employee Name] Date: [mm/dd/yyyy]
From: [Name, Title]
This notice updates the designation notice we gave you on [date of prior
notice]. It replaces the information marked below. Everything else in the prior
notice stays the same.
Use this form when the information in an earlier designation notice has
changed, for example when the entitlement is exhausted mid-leave, the approved
dates move, the paid-leave arrangement changes, or the amount counted changes.
1. PRIOR NOTICE BEING UPDATED
Date of prior designation notice: [mm/dd/yyyy]
Qualifying reason covered: [reason]
Originally approved dates: [start] through [end]
2. WHAT HAS CHANGED
[ ] ENTITLEMENT EXHAUSTED.
As of [date], you have used your full [12 / 26] weeks of FMLA leave for the
applicable 12-month period. Absences on and after that date are not
FMLA-protected and will be handled under [policy].
Previously: [old arrangement]. Updated: [new arrangement], including
premium payment terms of [amount, due date, grace period].
[ ] RETURN-TO-WORK REQUIREMENT HAS CHANGED.
[describe]
[ ] OTHER: [describe]
3. EFFECTIVE DATE AND WHAT TO DO
This change takes effect [date]. If you have questions or believe any figure
here is wrong, contact [Name, title, phone, email] promptly so we can review it
with you.
Delivered by: [ ] hand [ ] email [ ] mail to address of record, on
[mm/dd/yyyy] by [Name].
Employer signature: __ Date: _
DISCLAIMER: This is a sample template for general information only and is not
legal advice. Where information in a designation notice changes, written notice
of the change is generally required within five business days of the employee
next giving notice of a need for leave. Have a qualified employment attorney
review before use.
The Five-Business-Day Rule
The deadline is five business days from having enough information to determine whether the leave is for a qualifying reason, absent extenuating circumstances. The word doing the work is enough. It is not five days from the leave request, and it is not five days from when you get around to reviewing the file.
When the Clock Actually Starts
The federal model form states that the required information must be provided within five business days of the employer having enough information to determine whether the leave is for an FMLA-qualifying reason (U.S. Department of Labor). Where a certification is required, that is normally the day a complete and sufficient certification arrives. The Wage and Hour Division puts it the same way: when the employer has enough information to determine whether the leave is being taken for a qualifying reason, it must notify the employee whether the leave has or has not been designated as FMLA leave within five business days, absent extenuating circumstances (DOL FMLA Advisor).
The operational fix is unglamorous and works: date-stamp every certification the day it arrives, and calendar the fifth business day at the same moment. Most missed deadlines are not judgment calls. They are documents sitting unopened in a shared inbox while everyone assumes someone else is handling the medical leave.
WH-381 vs WH-382
Three different federal forms show up in a single FMLA leave and they are routinely confused, usually by sending the eligibility notice and assuming the designation is handled. It is not. They serve different purposes at different points in the sequence.
Form
What it does
When it goes out
WH-381, Notice of Eligibility and Rights and Responsibilities
Says whether the employee is eligible and explains obligations, certification requirements, and consequences
Within five business days of the leave request or of learning leave may qualify
WH-380-E and WH-380-F, Medical Certification
Collects the health care provider information needed to decide whether the leave qualifies
Usually sent with the eligibility notice; employee gets at least 15 calendar days to return it
WH-382, Designation Notice
Says whether the leave is designated as FMLA and how much counts against the entitlement
Within five business days of having enough information to decide
Both bookend notices can be needed even when the answer is no. The eligibility notice marks an employee as ineligible; the designation notice marks leave as denied or the entitlement as exhausted. Skipping the second one because the answer was negative is a common and avoidable gap in the leave file.
Common Costly Mistakes
Four points separate a notice that protects you from one that creates exposure. Each is a rule people know exists but apply loosely, and each has a specific consequence attached.
Five business days, counted from the right moment
The clock does not start when the employee first mentions a leave. It starts when you have enough information to decide whether the leave qualifies, which in most cases means the day a complete and sufficient certification lands. From that point you have five business days, absent extenuating circumstances, to put the designation in writing. The practical trap is the opposite of what people expect: employers who sit on a complete certification for two weeks while they think about it have already blown the deadline, while employers who send the notice the same day the request comes in, before any certification, are early rather than late and simply need to update the notice if the facts change. Date-stamp the certification when it arrives and calendar the fifth business day. This is general information, not legal advice.
Fitness-for-duty: flag it now or lose it
If you want a return-to-work certification, you have to say so in the designation notice. If you also want that certification to address whether the employee can perform the essential functions of the job, you must say that in the notice and attach a written list of those essential functions. Get this right and you may delay reinstatement until the certification arrives. Get it wrong, and the regulations are direct about the consequence: an employer may delay restoration until the certification is submitted unless the employer failed to give the required notice. There is one narrow exception. If your handbook clearly states that fitness-for-duty certification is required in specific circumstances, written notice with the designation is not required, but oral notice still has to come no later than the designation notice. This is general information, not legal advice.
Incomplete is not the same as insufficient
These two words do different work, and the conditional notice should name which one applies. A certification is incomplete when a required entry is simply blank. It is insufficient when the entries are filled in but the information is vague, ambiguous, or non-responsive. In either case you cannot just deny the leave. You must state in writing what additional information is needed and give the employee seven calendar days to cure the deficiency, extended where a cure is not practicable despite the employee’s diligent good faith efforts. Only after that opportunity passes without a complete and sufficient certification may the leave be denied. Vague requests such as asking for more detail do not satisfy this; list the specific blank entries or the specific unclear answers. This is general information, not legal advice.
A late notice is fixable, a harmful one is not
Missing the deadline is not automatically fatal. The regulations allow retroactive designation with appropriate notice to the employee, provided the failure to designate on time does not cause harm or injury to the employee. Employer and employee can also mutually agree to designate leave retroactively in any case where the leave would qualify. What creates real exposure is harm: if the delay causes the employee to suffer a loss, the failure can amount to interference with FMLA rights, with liability for lost compensation and benefits and other relief. The pattern that produces harm is predictable. An employee takes weeks of absence believing it is ordinary paid time off, arranges their year around still having a full entitlement, and then learns after the fact that it all counted. Designate promptly and the question never comes up. This is general information, not legal advice.
The Fitness-for-Duty Consequence, Stated Plainly
An employer may delay restoring an employee to work until a required fitness-for-duty certification is submitted, unless the employer failed to provide the notice required with the designation (29 CFR 825.312). That single clause is the reason the fitness-for-duty template exists as its own version rather than a checkbox someone forgets. Return-to-work conditions can also raise ADA obligations. This is general information, not legal advice.
The seven-day cure rule deserves its own emphasis because it is where small employers most often go wrong. A certification that comes back half-filled is not grounds for denial. You have to say in writing which entries are blank or unclear and give the employee seven calendar days to fix them (29 CFR 825.305). Only after that window closes without a complete and sufficient certification may the leave be denied.
Without an HR Department
A large employer runs designation notices through a leave administrator who does nothing else. A 60-person company hits 50 employees, becomes covered, and discovers the job belongs to whoever happens to handle HR that quarter. The rules are identical either way. What changes is that nobody has done it before, so the fields that look ambiguous stall the whole notice.
Here is what to actually write in the five fields that most often stop a first-time sender.
Field
What stalls people
What to write
12-month leave year
Nobody remembers choosing one
State the method you actually apply and use it consistently: calendar year, fixed year, forward from first use, or rolling backward. Pick one, put it in your leave policy, and copy it here.
Amount counted
The end date is not known yet
Give the figure for the approved dates and say the notice will be updated if the leave extends. Use the change-of-designation template when it does.
Paid leave substitution
Unclear whether you can require it
State your policy plainly: required, optional, or not applicable. If required, say that the paid leave runs concurrently and counts against the entitlement.
Counting increment
Intermittent hours look impossible to track
Use the smallest increment you already use for other leave in your timekeeping system. Do not invent a new one for FMLA.
Essential functions
No written job description exists
Write five to eight concrete functions with frequency and physical requirements. This is only needed if you require a fitness-for-duty certification to address them.
Two Habits That Prevent Most Problems
First, date-stamp certifications the day they arrive and calendar the fifth business day immediately. Second, keep a running entitlement balance per employee per leave year, so the figure in the next notice is not a guess. Medical certifications belong in a confidential file separate from the personnel file, while the designation notice itself lives with the leave record. This is general information, not legal advice.
California and State Rules
The federal form is a federal form. It does not carry state leave requirements, and in California that gap is wide enough to matter for businesses far below the federal threshold.
Five Employees, Not Fifty
California's Family Rights Act requires employers with five or more employees to provide eligible employees with job-protected family and medical leave, while the FMLA generally covers private employers with 50 or more (California Civil Rights Department). A 12-person California business can owe state leave obligations without being a federal FMLA employer at all, in which case the federal designation notice is not the document it needs.
Where both statutes apply, the leaves generally run concurrently but the eligibility rules and covered relationships are not identical, and pregnancy disability leave is a separate entitlement with its own health-coverage rules on top. The practical answer is a combined designation addressing both, not the federal form alone. Our California compliance guide covers the wider picture, and the side-by-side comparison covers where the two diverge.
Other states matter too, in a quieter way. States with paid family and medical leave programs add their own notices and claim processes, and state paid sick leave can create protected absences that never touch the FMLA at all. Apply the law of the state where the employee actually works, including remote employees, and re-check it periodically rather than assuming last year's list still holds.
Send, Sign, and Store
A designation notice does its job when it goes out on time, reaches the employee provably, and stays findable two years later when someone asks how a leave was counted. The templates handle the first part. The rest is process.
Date the trigger
Record the day the complete certification or other deciding information arrived. That date, not the leave request, starts the five-business-day clock.
Pick and fill the notice
Choose approval, conditional, denial, intermittent, or fitness-for-duty, and fill in the count, the leave year, and the paid-leave terms.
Deliver and prove it
Hand it over, email it, or mail it to the address of record, and keep a dated record of how and when it went out.
Store and track the balance
File the signed notice with the leave record, keep medical documents separate, and track the running entitlement so the next notice is accurate.
The failure mode is rarely the wording. It is a notice that was written but never sent, sent but never recorded, or filed somewhere nobody can find during an audit or a claim. Delivery method matters here: hand it over, email it, or mail it to the address of record, and write down which one and when.
To run this without a spreadsheet, FirstHR stores the designation notice against the employee profile, captures acknowledgment with e-signature so there is a dated record of receipt, and keeps it alongside the rest of the employee's document history. FirstHR is an onboarding and HR platform, not a law firm and not a leave administrator: it does not calculate FMLA entitlement, adjudicate certifications, or track leave balances for you, so pair it with your timekeeping system and your employment counsel. Applicant tracking is coming soon to FirstHR.
Key Takeaways
A designation notice tells the employee whether leave is designated as FMLA and how much counts against their entitlement. It must be in writing.
The deadline is five business days from having enough information to decide, which usually means from a complete certification, not from the leave request.
Form WH-382 is optional and its printed expiration date does not affect validity; a compliant custom version is equally acceptable.
Flag any fitness-for-duty requirement in the designation notice, with an essential-functions list if the certification must address them, or you generally cannot require it later.
An incomplete or insufficient certification is not a denial. State in writing what is missing and give seven calendar days to cure.
Late designation can be fixed retroactively only if it caused the employee no harm; harm turns a paperwork lapse into interference. This is general information, not legal advice.
Frequently Asked Questions
What is an FMLA designation notice?
An FMLA designation notice is the employer’s written notice telling an employee whether their leave has been designated as FMLA-qualifying and how much of it will count against their FMLA entitlement. It is issued within five business days of the employer having enough information to decide, absent extenuating circumstances. The notice covers the decision itself, the amount counted in hours, days, or weeks, whether paid leave will be substituted and run concurrently, and whether a fitness-for-duty certification will be required to return to work. It is an employer-to-employee document: the employer is responsible in all circumstances for designating leave and giving notice, and neither side can decline FMLA protection for leave that qualifies. This is general information, not legal advice.
Is Form WH-382 required?
No. Use of the federal model form is optional, but the written designation notice itself is mandatory. Employers may use Form WH-382 or create their own version, provided it meets all the legal requirements. That is why a custom template can be a better choice than the bare federal PDF: you can write it in plain language, add your own leave-year definition and contact details, build in the delivery record, and keep separate versions for approval, conditional, denial, and intermittent decisions instead of working checkbox by checkbox through one general form. What you cannot do is drop any required element. The decision, the amount counted, the paid-leave terms, and any fitness-for-duty requirement all have to be there. This is general information, not legal advice.
The WH-382 shows an expiration date. Can I still use it?
Yes. The expiration date printed on the federal FMLA forms relates to the information collection approval required by the Office of Management and Budget, not to the substance of the notice. The Department of Labor states directly that the content of the optional-use forms is still applicable regardless of the expiration date. This confuses a lot of HR staff, who see a date in the past on the top corner of the form and assume the form is dead. It is not. The underlying regulatory requirements have not changed with the date, and a fully completed form still provides the employee with the required information. If you would rather not field the question at all, a custom template avoids the printed expiration date entirely. This is general information, not legal advice.
How long do I have to send the designation notice?
Five business days from the moment you have enough information to determine whether the leave is for an FMLA-qualifying reason, absent extenuating circumstances. In practice that usually means five business days from receiving a complete and sufficient medical certification, not five days from the leave request. If you already have enough information when the employee first asks, you may issue the designation notice right away. The most common failure is treating the certification as something to review at leisure: it arrives, sits in an inbox for two weeks, and the deadline has already passed by the time anyone opens it. Date-stamp certifications on arrival and calendar the fifth business day the same day. This is general information, not legal advice.
What happens if I do not send a designation notice?
You may still be able to designate the leave retroactively. The regulations permit retroactive designation with appropriate notice to the employee, provided the failure to designate on time does not cause harm or injury to the employee, and an employer and employee may also mutually agree to retroactive designation in any case where the leave would qualify. The risk is harm. If the delay causes the employee a real loss, the failure can constitute interference with FMLA rights, exposing the employer to lost compensation and benefits, other actual monetary losses, and equitable relief such as reinstatement. The classic harmful pattern is an employee who plans around still having a full entitlement and only later learns that past absences consumed it. This is general information, not legal advice.
Do I need a separate designation notice for each leave?
One designation notice is required for each FMLA-qualifying reason in the applicable 12-month leave year, whether the leave is taken as a continuous block or intermittently. So an employee with an approved intermittent leave for their own condition does not need a new notice for every absence. But if the same employee later needs leave for a different qualifying reason, such as caring for a parent, that reason gets its own designation notice. There is a second trigger people miss: if the information in a designation notice changes, for example when the entitlement is exhausted, written notice of the change is required within five business days of the employee’s next notice of a need for leave. That is what the change-of-designation template on this page is for. This is general information, not legal advice.
Can I require a fitness-for-duty certification after the leave starts?
Generally not, if you did not flag it in the designation notice. The requirement has to be stated with the designation notice, and if you want the certification to address the employee’s ability to perform the essential functions of the position, you must say so in the notice and include a written list of those essential functions. The consequence is concrete: an employer may delay restoring an employee to work until the certification is submitted, unless the employer failed to give the required notice. One narrow exception exists. If your handbook clearly provides that fitness-for-duty certification is required in specific circumstances, written notice with the designation is not required, but oral notice must still be given no later than with the designation notice. This is general information, not legal advice.
Does the federal form work in California?
Not on its own. California’s Family Rights Act covers private employers with five or more employees, while the FMLA covers employers with 50 or more, so a California business can owe state leave obligations without being a federal FMLA employer at all. Where both apply, the leaves usually run concurrently but the rules are not identical, and pregnancy disability leave adds a separate entitlement with its own health-coverage rules. The practical answer for a California employer is a combined designation that addresses both statutes and, where relevant, pregnancy disability leave, rather than the federal form used alone. Several other states with their own paid family or medical leave programs layer additional notices on top. Confirm the requirements in every state where you have employees. This is general information, not legal advice.
