Free HR template

FMLA Designation Letter Template

An FMLA designation letter tells an employee in writing that their leave is designated as FMLA leave. Catapult’s free Word template is a cover letter you send with the FMLA designation notice, such as DOL form WH-382. It covers leave dates, the return date, paid time off, benefit premiums, and state leave law.

  • Word (.docx)
  • Leave management
  • How-to and checklist

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What’s included

What’s in the FMLA Designation Letter template

The file opens with a guide for HR, then the letter with highlighted fields to replace.

  • How to use this template

    Steps for replacing the logo and highlighted fields, choosing options, and deleting pay and benefits lines that do not apply.

  • Before you send checklist

    Enclose the designation notice, confirm dates and paid leave against the medical certification and your policy, check state leave law, and confirm benefits with your carrier or broker.

  • Leave approval

    Confirms the FMLA-approved leave dates and refers to the enclosed designation notice.

  • Employee responsibilities

    Keeping HR informed of changes, requesting extensions, and a reference to the ADA interactive process if more leave may be needed.

  • Return-to-work date

    The designated return date and what happens if the employee does not return or ask to extend.

  • Pay and benefits during leave

    Paycheck timing, required use of paid time off, benefit deductions, paying premiums directly, and unpaid leave once paid time runs out.

  • Coverage changes and COBRA

    A note that leave can be a qualifying event for plan changes within 30 days, and that COBRA information follows if coverage ends.

  • State law review note

    A reminder that some states provide more leave, including paid family and medical leave.

Situations it covers

  • Leave that starts paid and later becomes unpaid
  • Required use of paid time off, vacation, or sick leave
  • Employees who pay premiums directly once payroll deductions stop

Checklist

What to include in an FMLA designation letter

  • Approved FMLA leave dates
  • A reference to the enclosed designation notice
  • How to report changes or request an extension
  • The designated return date
  • Paycheck timing and required use of paid time off
  • How benefit premiums are paid once paid time runs out
  • Plan change window and COBRA information
  • Contact details for questions

When to use it

What the FMLA Designation Letter template helps with

Use it once you have enough information to decide that an employee’s leave qualifies under the FMLA.

It helps you

  • Confirm in writing that leave is designated as FMLA leave.
  • Explain how pay, paid time off, and benefit premiums work during leave.
  • Set a clear return date and the steps for requesting an extension.
  • Send alongside the required designation notice so nothing is missed.

Who should use it

HR teams at employers covered by the FMLA. That includes private employers with 50 or more employees in 20 or more workweeks in the current or previous calendar year.

How to use it

How to use the FMLA Designation Letter template

  1. Confirm the employee is eligible and the leave qualifies, based on the information you received.
  2. Complete the designation notice, such as form WH-382.
  3. Fill in the letter’s dates, return date, and paid leave requirement, and delete pay and benefits lines that do not apply.
  4. Check state leave law and confirm premium details with your carrier or broker.
  5. Delete the guidance notes and send the letter with the designation notice within five business days.

Common mistakes

Mistakes to avoid

Missing the five-business-day window

Designate within five business days of having enough information, absent extenuating circumstances.

Leaving out the amount of leave

The notice must state how much leave counts against the entitlement, if known.

Forgetting fitness-for-duty

If you will require a fitness-for-duty certification, say so in the designation notice.

Ignoring state law

Some states give more leave, including paid family and medical leave.

Unclear premium instructions

Tell the employee how their share of premiums is paid once paid time runs out.

Compliance notes

What to check before you use it

Employment laws vary by state and change over time. These notes are general and point to the official sources.

Five business days

The employer must notify the employee whether leave will be designated as FMLA-qualifying within five business days, absent extenuating circumstances, after it has enough information to decide. The notice must be in writing.

Source: 29 CFR 825.300, Employer notice requirements (eCFR)

What the notice must say

The designation notice must state the amount of leave counted against the entitlement if known, whether paid leave will be substituted, and whether a fitness-for-duty certification is required to return.

Source: 29 CFR 825.300, Employer notice requirements (eCFR)

Form WH-382

The Department of Labor’s WH-382 designation notice is an optional-use form. Employers can use their own version if it contains the same information.

Source: U.S. Department of Labor, FMLA forms including WH-381 and WH-382

Health coverage

During FMLA leave, the employer must maintain the employee’s group health coverage on the same conditions as if the employee had been continuously employed.

Source: 29 CFR 825.209, Maintenance of employee benefits (eCFR)

Eligibility

Employees are eligible if they have worked for a covered employer for at least 12 months, have at least 1,250 hours of service in the 12 months before leave, and work at a location with at least 50 employees within 75 miles.

Source: U.S. Department of Labor, Fact Sheet #28: The Family and Medical Leave Act

Not legal advice. This page and the template are general information, not legal advice. For your situation, talk to an employment attorney or HR advisor. Catapult members can bring employment law questions to our advisors as part of their membership, and they can have an advisor review the completed letter before it goes out.

FAQ

FMLA Designation Letter template questions

What is an FMLA designation notice?

It is the written notice an employer gives an employee stating whether their leave is designated as FMLA leave and how much leave will be counted against their entitlement. The Department of Labor offers form WH-382 for this purpose.

When must an employer send the FMLA designation notice?

Within five business days, absent extenuating circumstances, after the employer has enough information to determine whether the leave is FMLA-qualifying, under 29 CFR 825.300(d).

What must the designation notice include?

Whether the leave is designated as FMLA leave, the amount of leave counted against the entitlement if known, whether paid leave will be substituted, and whether a fitness-for-duty certification is required to return to work.

What is the difference between this letter and form WH-382?

Form WH-382 is the Department of Labor’s optional designation notice. Catapult’s template is a cover letter sent with the notice that explains the return date, paid time off, benefit premiums, and next steps in plain language.

Do health benefits continue during FMLA leave?

Yes. The employer must maintain group health coverage on the same conditions as if the employee were still working. The letter explains how the employee’s share of premiums is collected once paid time off runs out.

Can leave be designated as FMLA after it starts?

Yes, in some cases. An employer can designate leave retroactively with appropriate notice if the delay does not harm the employee, or if the employer and employee agree.

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Sources

Last reviewed: October 2026.