How to Fill Out and Submit the Nevada FMLA Leave Form

To request FMLA leave in Nevada, you fill out either the state’s HR-60 form if you work for a Nevada state agency or a federal Department of Labor certification form (most often WH-380-E or WH-380-F) if you work for a private employer, attach medical certification from your health care provider, and submit the package to your employer’s HR office. The Nevada FMLA leave form itself is only part of the paperwork: the medical certification that goes with it is usually what determines whether your leave gets approved on the first pass. Deadlines are tight once the process starts, so getting each piece right the first time matters.

Which Form You Need

Nevada state government employees use HR-60, the FMLA Leave of Absence Form issued by the Division of Human Resource Management. It’s a PDF you download from hr.nv.gov.¹ If you’ve seen older guidance referring to “NPD-46,” that’s the same form under its previous name; the current designation is HR-60.

Private-sector employees in Nevada use the federal DOL certification forms. The two you’ll most likely need are WH-380-E (leave for your own serious health condition) and WH-380-F (leave to care for a spouse, child, or parent).² Both are available at dol.gov/agencies/whd/fmla/forms. Your employer may add its own internal request form on top of the DOL certification, but it can’t demand more information than the federal form collects.

Before you spend time on either form, confirm you qualify: at least 12 months with the employer, at least 1,250 hours of actual work in the 12 months before leave starts, and at least 50 employees within 75 miles of your worksite.³ The 1,250 hours counts actual compensable work only, not vacation or paid sick time.⁴

Filling Out HR-60 (Nevada State Employees)

HR-60 runs two pages. The first page is yours to complete; the second deals with certification attachments and signatures.

Start with the identifying fields: your full name, employee ID, job title, employing agency, and supervisor. Then mark the reason for your leave. The form tracks the federal qualifying categories:

Your own serious health condition that keeps you from doing your job.
Care for a spouse, child, or parent with a serious health condition.
Birth of your child and bonding time with the newborn.
Placement of a child with you for adoption or foster care.
A qualifying exigency arising from a family member’s covered active military duty.
Care for a covered servicemember with a serious injury or illness (up to 26 workweeks in a single 12-month period, combined with any other FMLA leave).

Next, enter the dates. Write the expected start date and expected return date. Choose the leave structure: a continuous block (you’re out the whole time), intermittent leave (periodic absences as your condition requires), or a reduced schedule (you keep working but at fewer hours). Be as specific as you can. Vague scheduling leads to confusion later about whether a given absence counts.

The second page lists the federal certification forms that must be attached depending on the reason for leave: WH-380-E, WH-380-F, WH-384, WH-385, and WH-385-V.¹ Your health care provider fills these out; you attach the completed form to HR-60. Sign and date where indicated.

Filling Out the Federal Form (Private-Sector Employees)

If you’re using WH-380-E or WH-380-F, you fill in the employee section at the top: your name, job title, department, and supervisor’s name. The rest of the form is your health care provider’s section, which you hand off for completion.

On the employee portion, specify the leave structure the same way you would on HR-60: continuous, intermittent, or reduced schedule. For intermittent leave, give an honest estimate of how often you’ll need time off and how long each absence will last. For reduced-schedule leave, state the hours you plan to work.

Medical Certification: What Your Provider Must Write

The medical certification is the attachment that decides most FMLA requests. Federal rules require the provider to include their name, contact information, and specialty; the approximate date the condition started; and how long it’s expected to last. The provider must also describe medical facts about the condition — symptoms, diagnosis, hospitalization, doctor visits, prescribed medications, or treatment referrals — in enough detail to support the need for leave.⁵

If the leave is for your own condition, the certification must explain why you can’t perform the essential functions of your job and estimate how long that limitation will last. If it’s to care for a family member, the certification must establish that the family member needs your care and estimate how often and for how long you’ll be absent.⁶

Intermittent leave is where certifications most often fall short. The provider has to explain the medical necessity of taking leave in pieces rather than one block, and must estimate both the frequency and the duration of flare-ups.⁶ Writing “occasional flare-ups” without numbers is the most common reason paperwork gets kicked back. Ask your provider to put it in concrete terms, something like “episodes expected 2–3 times per month, lasting 1–2 days each.”

Keep in mind that “serious health condition” has a specific meaning: an illness, injury, or condition that involves inpatient care or continuing treatment by a health care provider. Cancer treatment, surgery with recovery time, chronic conditions like asthma or diabetes that cause periodic incapacity, and pregnancy qualify. Routine colds, the flu, earaches, and minor stomach bugs generally don’t unless they develop complications.⁷

Some providers charge a fee to complete FMLA paperwork, often around $25. That cost is yours, not your employer’s.

Notice Timing and How to Submit

If your need for leave is foreseeable — a scheduled surgery, an expected birth, planned treatment — you must give your employer at least 30 days of advance notice. When 30 days isn’t possible because the need comes up suddenly, you must give notice as soon as practicable, which generally means the same day you learn about it or the next business day.⁸

Submit the completed form and the medical certification to whoever your employer designates. For state employees that’s your agency’s HR coordinator; in private employment, it’s usually your HR department or a leave administrator. Many employers accept submissions through a secure portal. If yours wants paper, send it by certified mail or get a date-stamped receipt. You want written proof of when the form left your hands.

Once your employer requests medical certification, you have 15 calendar days to return it. If you can’t meet that window despite a good-faith effort, the deadline can be extended, but you have to show why.⁹ Missing it without a reasonable explanation can mean losing FMLA protection for the absence.

What Happens After You Submit

Your employer owes you two written notices. The first is an eligibility notice, due within five business days of your request. It tells you whether you meet the FMLA eligibility criteria, and if you don’t, it must state at least one reason why. The employer sends a rights and responsibilities notice at the same time, laying out what’s expected of you during leave, including any obligation to submit medical certification.¹⁰

The second is a designation notice, due within five business days after the employer has enough information to decide whether your leave qualifies.¹¹ This notice confirms whether your leave counts against your 12-week FMLA entitlement, whether you have to provide periodic status updates, and whether you’ll need a fitness-for-duty certification before returning. Read it carefully. It governs the rest of your leave.

If Your Paperwork Comes Back Incomplete

If the form is missing information or the medical certification is insufficient, your employer must tell you in writing exactly what’s needed.⁹ You then have seven calendar days to cure the deficiency. That’s a short window, especially if your provider’s office doesn’t turn things around quickly. The best defense is a thorough first submission with specific dates, frequencies, and durations.

Nevada Paid Leave Rules That Affect Your Request

FMLA leave is unpaid by default under federal law.¹² You can choose to substitute accrued paid leave to keep a paycheck coming, and your employer can require you to use accrued paid leave before going unpaid.¹³ Either way, the paid leave runs concurrently with FMLA. It doesn’t extend the 12-week clock.

For Nevada state employees, this isn’t optional. Under the Nevada Administrative Code, you must exhaust all accrued sick leave, annual leave, compensatory time, and catastrophic leave you’re eligible to use based on the nature of your absence before you can go on leave without pay. All of that runs concurrently with your FMLA entitlement, and the 12-month period is measured backward from the date you use any FMLA leave.¹⁴

For private employers covered by Nevada’s SB 312 paid leave law (50 or more employees in the state), you accrue paid leave at 0.01923 hours per hour worked and can begin using it on your 90th day. You don’t have to give a reason to use SB 312 leave. If you’re taking FMLA and have SB 312 leave available, the FMLA notice and certification requirements still apply to the FMLA portion.¹⁵ The Labor Commissioner’s guidance doesn’t explicitly address whether SB 312 leave runs concurrently with FMLA, so ask your HR office how the two interact in your workplace.

Military Family Leave Forms

If your leave is tied to a family member’s military service, you use different certification forms. WH-384 covers qualifying exigency leave arising from a spouse, child, or parent’s covered active duty, including short-notice deployment, military ceremonies, childcare arrangements, financial and legal arrangements, counseling, and time with the servicemember during rest and recuperation (up to 15 calendar days).¹⁶ Use of WH-384 is optional; you can provide the required information in any format, including official military documents, and your employer can’t reject your certification just because you didn’t use the specific form.²

Military caregiver leave for a spouse, child, parent, or next of kin of a covered servicemember with a serious injury or illness uses WH-385 (current servicemember) or WH-385-V (veteran).² This category allows up to 26 workweeks in a single 12-month period that starts on the first day you take this leave.¹⁷

1
Nevada Department of Administration. Nevada Division of Human Resource Management – FMLA Leave of Absence Form
2
U.S. Department of Labor. FMLA: Forms
3
eCFR. 29 CFR 825.110 – Eligible Employee
4
eCFR. 29 CFR 825.110 – Eligible Employee
5
eCFR. 29 CFR 825.306 – Content of Medical Certification
6
U.S. Department of Labor. Medical Certification under the Family and Medical Leave Act
7
eCFR. 29 CFR 825.113 – Serious Health Condition
8
eCFR. 29 CFR 825.302 – Employee Notice Requirements for Foreseeable FMLA Leave
9
U.S. Department of Labor. Family and Medical Leave Act Advisor – Medical Certification – General
10
U.S. Department of Labor. Fact Sheet 28D – Employer Notification Requirements under the FMLA
11
eCFR. 29 CFR 825.300 – Employer Notification Requirements
12
Office of the Law Revision Counsel. 29 USC 2612 – Leave Requirement
13
eCFR. 29 CFR 825.207 – Substitution of Paid Leave
14
Nevada Legislature. NAC Chapter 284 – State Human Resources System
15
Nevada Office of the Labor Commissioner. Advisory Opinion – Senate Bill 312 Paid Leave
16
U.S. Department of Labor. Qualifying Exigency Leave under the Family and Medical Leave Act
17
U.S. Department of Labor. Fact Sheet 28M(a) – Military Caregiver Leave for a Current Servicemember under the Family and Medical Leave Act