Designation Notice (Family and Medical Leave Act) U.S. Department of Labor Wage and Hour Division Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA-protected and the employer must inform the employee of the amount of leave that will be counted against the employee222s FMLA leave entitlement. In order to determine whether leave is covered under the FMLA, the employer may request that the leave be supported by a certification. If the certification is incomplete or insufficient, the employer must state in writing what additional information is necessary to make the certification complete and sufficient. While use of this form by employers is optional, a fully completed Form H-382 provides an easy method of providing employees with the written information required by 29 C.F.R. 247247 825.300(c), 825.301, and 825.305(c). W Your FMLA leave request is approved. All leave taken for this reason will be designated as FMLA leave. The FMLA requires that you notify us as soon as practicable if dates of scheduled leave change or are extended, or were initially unknown. Based on the information you have provided to date, we are providing the following information about the amount of time that will be counted against your leave entitlement: Please be advised (check if applicable): is is not Additional information is needed to determine if your FMLA leave request can be approved: PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT DO NOT SEND THE COMPLETED FORM TO THE WAGE AND HOUR DIVISION. American LegalNet, Inc. www.FormsWorkFlow.com