Affordable Care Act -Model Notices
Notice to Employees of Coverage Options

Form I-9:

Updated FMLA Forms, (amending to February 28, 2015)

Certification of Healthcare
Provider for Employee’s Serious Health Condition WH380E

Certification of Health Care
Provider for Family Member’s Serious Health Condition WH380-F

Notice of Eligibility and
Rights & Responsibilities WH381

Designation Notice

Certification of Qualifying
Exigency for Military Family Leave WH384

Certification for Serious
Injury or Illness of a Current Servicemember –for Military Family Leave