Welcome to module 2 in this module we'll review the forms provided by the Department of Labor for family medical leave situations the website address for the Department of Labor is located in the top left-hand corner of the screen WW DOL gov this form entitled certification of health care provider for employees serious health condition is the form that a supervisor should give to an employee when he or she is taking a leave for his or her own serious health condition this form is also referred to as form WH 380 II Section 1 of the form is for the supervisor to complete and as you can see it's very brief it asks with the employer name and contact information the employee's job title and regular work schedule and the essential job functions if you don't wish to list the essential job functions you can simply attach a job description one thing to note is the paragraph above that states that employers must keep all the medical records related to Family Medical Leave and that these records should be kept outside the personnel file because they contain confidential medical information the next section of the form is for the employee to complete and as you can see it's very brief it only asks for the employee's name right above the employees name is a sentence that we should note it states here your employer must give you at least 15 calendar days to return this form so when the employee takes the form to his or her doctor they are entitled to 15 calendar days to get it back to the employer if you don't receive the form back within the 15 days please call Human Resources and will contact the employee and assist you with getting the...
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About Form WH-380-E
Important Notice: If you are taking FMLA leave as a result of a new job, you must be provided notice that your request for FMLA leave has been approved by the employment office. Employers that are covered by the Family and Medical Leave Act (FMLA) must provide employers with written leave policies, including any restrictions, requirements, or penalties for non-compliance (see Fact Sheet #5 — Employer Notification Requirements Regarding Family and Medical Leave Act Leave). It is unlawful for an employer to make any false or misleading statements in connection with a request for FMLA leave. In addition, employers will continue to be subject to enforcement actions, including fines, for having employees without valid medical coverage leave the employer's work. It is illegal to retaliate against a supervisor or other employee who requests leave for his or her own medical condition. It is also illegal to pay, provide, or offer money, employment benefits, or any other thing of value to employees for requesting FMLA leave. If your leave is approved, you may be eligible to be reimbursed for actual expenses. A leave from work under the FMLA can last from any time to any of the following: 12 workweeks in all, except that you can take a leave of absence only for a total of 26 workweeks. To qualify, you have to meet any of the requirements for an absence under FMLA. If you do not satisfy one or more of those requirements, you do not qualify for FMLA leave. Eligibility To be eligible for FMLA leave, you must be: A member of the Armed Forces of the United States or Armed Forces Reserve (or former members of those armed forces). An employee, because of the length or severity of your own serious medical condition arising from or aggravated by service in the uniformed services. A member of the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA), National Science Foundation (NSF), National Oceanic and Atmospheric Administration National Marine Fisheries Service, or U.S. Customs and Border Protection, and the eligible employee has completed any period of continuous active service during which they were assigned to work at all times while on leave under FMLA. Part-time employees with two or more full-time employees who perform the essential functions of their jobs.
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FAQ - Form WH-380-E
What is the purpose of Form WH-380-E?
The purpose of Form WH-380-E is to record a notice or other document that has been used in the transaction.
Who should complete Form WH-380-E?
To complete Form WH-380-E (PDF), fill out the information on the following forms:
Submit completed forms with your application or with your payment to:
Health and Human Services
Payment Service Center
PO Box 107775
Austin, TX 78711
Payment information
Health insurance companies are responsible for verifying the identity and eligibility of each person they enroll, as well as ensuring that individuals are not charged more or denied coverage as a result of the enrollment. To verify the eligibility of a person to enroll in the health insurance plan, a health insurance carrier will request a person's health insurance coverage certificate or certification, or their information from the National Insurance Card. In addition, the carrier may request the applicant's passport (or other national ID card), birth certificate, or other identification.
If you're applying with a representative — such as a licensed practical or licensed vocational nurse in Texas — you can submit two documents each (health insurance certificate and health insurance application). You can use Form WH-383-A (PDF) to provide an authorized electronic signature as an authorization to submit an electronic application with the carrier. A copy of Form WH-383-A is included with all forms you apply with.
If you will not be filing your application with the State of Texas, or if you plan to be a federal contractor, you may submit an application electronically. Visit the Office of Public Sector Electronic Applications to submit application electronically. The Office has instructions for how to send a completed electronic application.
Application fees
To complete a health insurance application with Health and Human Services, you can use an online calculator. The online calculator will automatically subtract the Federal Employee Health Benefits Program (FEB) contribution from your health insurance premium, with no additional fees required on your part. Once you've entered an estimated monthly Premium, the calculator will automatically estimate the payment amount for the next month if you do not change it or choose a different payment method. If you are a federal contractor, you will not be charged any fees for this service.
If you'll be filing your health insurance application with the State of Texas, you will either submit your application by mail or download an application online.
When do I need to complete Form WH-380-E?
Your employer may require you to complete Form WH-380-E on the 1st day of each pay period.
You must file and pay electronically if you meet the following requirements:
You earn minimum wages of 7.35 per hour (or 14,080 for 2017, the last full calendar year in which you earned at least 300 per month). Payments must be made to the EFT card or EFT fund account you established with Aetna. An EFT card is required if you are an EFT card plan subscriber. Your pay period must fall within 10 calendar days after the end of the pay period in which your W-2 is due. Your employer must make Form WH-380-E available for viewing online, including making a copy available to you.
Your employment is covered by the federal Fair Labor Standards Act (FLEA) and covered by certain state labor laws or collective bargaining agreements. You should be aware that some employees cannot be covered by some federal protections listed above, and in some cases, states may provide additional rights and protections to certain groups of workers. In some instances, including if you have been employed by an affiliate that is subject to the jurisdiction and rules of a State and if we will reimburse you for any taxes, fees, or surcharges incurred, you will remain subject to federal and applicable state or local labor laws, including the overtime protections set forth in the FLEA.
Your employer can require you to file and pay electronically if any of the following circumstances apply:
Your employer does not provide you the option to take W-2 forms over the phone or online.
You are providing services or goods to a person or entity outside your work location or outside the United States.
You are paying dues or fees to a union or other labor organizer.
Furthermore, you are a federal employee who is paid on a salary basis.
Furthermore, you are covered by an IRS tax treaty.
Furthermore, you have been laid-off or are receiving termination payments from your former employer.
Furthermore, you plan to work in another country for a period of three months or more, or will be working on a temporary contract without benefits.
Furthermore, you have been in active duty in the Armed Forces of the United States on or after September 12, 1981.
Can I create my own Form WH-380-E?
Yes. Just create the Form in the Form Builder and send it to us via the email link provided.
Will the Form be reviewed?
No. Please note: all Form WH's are sent as a proof of payment from the buyer to us. No refunds will be given at point of sale.
Why am I sending my Form to you?
We need to know your full name and address, so we can send you your Form WH. It cannot be sent with any other payment, such as a PayPal credit or credit/debit card.
Will there be a way to make changes to my form once it has been created?
Yes. If one of your items is damaged in transit, or you want to change one of your choices to a different choice, you can change your form after you've submitted it to us.
Will my Form WH be accepted at the front desk, or as a gift?
Your Form WH is not currently accepted at the front desk. However, once your Form WH is created, it will be accepted as a gift at our store. (Unfortunately no change of mind can be made to an already created form.)
How will I be able to return an item I received as a gift or a proof of payment?
Sorry, the gift/proof of payment returned should return to us in the same condition as it was received. If you have a problem with the way it was received, please see our Return Policy for more details.
Are there any other details I should know?
When sending an email to customer service, please be sure to mention that you are sending a Form WH as proof of payment.
Once I have submitted an item, is it final?
Yes. Once a Form WH has been submitted, it cannot be changed.
What is my return policy?
At the end of the month, you may return (subject to applicable returns policy) any unused items you purchased from us. You are responsible for the cost of returning all items to us. Please remember, we are a licensed reseller who offer a lifetime warranty. Please note we do not charge a restocking fee to return items purchased from us.
What do I do if something breaks, or the product is defective?
We have the right to refuse all returns for any reason. In the case your purchase was defective, please e-mail customer service.
What should I do with Form WH-380-E when it’s complete?
The form is complete. You may request for you to check in or check-out your order. Your order will be shipped as soon as the order processing has started.
When will I receive my order?
Processing time: Within 1 to 2 business days (excluding Sunday, National Holiday and Public Holiday in the Philippines). The processing time will be adjusted according to the date input, the shipping mode, and destination country.
For countries of the following: China, Hong Kong, Japan, Taiwan, Hong Kong SAR, Indonesia, Malaysia, Macao SAR, Philippines, Singapore, Thailand, Hong Kong SAR, South Korea, Australia, New Zealand
Order Processing Time
What does the order processing time means?
The processing time is used to determine the processing time in the order processing process.
Your order total will be charged one week after the processing time. All orders processed during the same processing time will receive an identical charge.
When you submit a refund request within one week after completing the order, your refund will be processed the same day (no need to fax or mail the request).
To avoid delays in processing, we recommend you check and double-check the status of your order within 1 business day after placing the order. Otherwise, the order processing time can vary depending on the processing status.
How to check the order processing time:
1. When you make your transaction, please submit the order ID.
2. If the form was received properly, the processing time will be displayed at top right of this page. If your order is being processed for a change or for other reasons (such as missing items from your order, or an incorrect order number), please submit another order ID to avoid delays.
3. Please check in one week after you submit the order (this includes processing your return request).
Refund Information
How to claim refund?
1. If your order has not been dispatched to you by normal delivery service (DHL, EMS etc.), or you receive an order confirmation email, but your package has been shipped outside normal delivery service (DHL, EMS etc.), then you may claim your refund.
Please contact our customer service team by e-mail at to submit your reimbursement request.
2.
How do I get my Form WH-380-E?
If you are purchasing a Form WH-380-E online, you can print the Form WH-380-E from the link that we provide and send in your Form WH-380-E for filing to the IRS.
Please be sure to print the instructions from the online instructions for filing that are provided with your Form WH-380-E. You may also have to send in documentation for the forms you were supposed to fill out.
After you have completed the required information on each form, you can send it by mail or fax to the IRS. See the instructions given with your Form WH-380-E for sending in your Forms WH-377, WH-378, or WH-378A. The instructions will tell you how to send it to the IRS.
If I use another name under which I filed my Form W-2 tax return, such as my spouse, what should I do with the Form WH-380-E that I complete?
If you do not have any Form W-2 when you fill out your Form WH-380-E and you fill this form out using your other name or Social Security Number, you will not be able to file Form WH-380-E, the tax return, if it uses the information from the Form W-2 that was filed using your name or Social Security Number.
What if you file a joint return, and you also fill out the Form W-2?
Under the Internal Revenue Code, you must file Form W-2 when you file any of the following. If you report income from a trade or business, you must file Form W-2.
If you file Form 1040 or Form 1040A, and you report a capital gain.
If you file a tax return for the year.
If you report income and expenses from a partnership, S corporation, trust, or other entity, you must file one Form 1065 for Schedule C. You need to complete Schedule C, Line 23, column (b), by inserting the following income amounts to be listed on your Form 1065:
The following information is included in your Form 1065 showing the source and payment sources for the amount listed in column (a).
If you only have to report one income amount listed in column (a) on your Form 1065, you can use the form without attaching any other information or forms.
What documents do I need to attach to my Form WH-380-E?
You must attach a list of all persons and entities that you know or have reasonable cause to believe are subject to the requirement that they report information to the IRS. This list should be current at the time you submit your Form WH-380. However, you must not include any persons or entities that you have reason to doubt that they are persons or entities subject to the requirement that they report information to the IRS. To help determine the extent of persons or entities on your list, use the following example. The following table presents the names and addresses for a number of different persons or entities. Note that the individuals and their addresses have been taken from the actual lists that were on file during the period of the investigation. Also note that the list of individuals and their addresses is not a complete list of all persons or entities who had addresses at both the address listed on the Form WH-380-E and the address listed on your Form 1120S-T.
(Names and addresses may be combined.)
Person or Entity Address Amount of Tax Liability 200,000.00 1
You do not need to complete any Form WH-380-E attached by the person or entity on your list. Note that when you file Form 2106 in lieu of Form WH-380-E, you must either:
Filed a Form 2106 as a single piece of paper attached to a paper copy of Form WH-380-E; or
Attach an amended Form 2106 as an attachment to your Form 1120S-T.
Form WH-380-E Does Not Provide Personal Information
In order to properly complete the Form WH-380-E, provide the personal information that is required to be reported. You do not need to provide the name, business name, trade or profession name or employment information on the Form 1120S-T. If you do not know whether the taxpayer you are investigating is an individual or a business with multiple entities, use the example provided in the next section.
Example of an Individual Taxpayer
Jack, a real estate agent, is audited. His Form 1120S-T shows that he filed a 2017 Form 1040 and an 2017 Form 1040A. Neither form shows his occupation for the year, but his Form 11038 shows that he holds a license from the Florida Real Estate Commissioner's Office.
What are the different types of Form WH-380-E?
The form may be:
1. Form WH-380-E. Complete and sign the original WH-380-E in either English or Spanish or in the language in which the business operates.
2. Form WH-480-E. You must sign the original Form WH-480-E in either English or Spanish or in the language in which the business operates.
3. Business and contact information requirements. The name, EIN and TIN of the applicant, along with other business and contact information.
4. Statement of foreign citizenship. Fill out an original Form WH-280.pdf and attach the original Form WH-380-E and 1 copy of the original passport.
5. Statement of address or mailing address. Fill out a form using the address used when filing the application, or use the address on the form if you were not required to file or to update the address.
6. Statement of ownership. The name(s) and location of the applicant or foreign entity.
7. Statement of ownership and authority. The name or other identifying name(s) identifying the person(s) who have authority for the application, including name(s) of all officers, directors, trustees and persons who hold the authority.
8. Declaration of tax residency. Sign the original Form WH-480-E in the English language or the language in which the business operates.
9. Declaration of eligibility. Sign the original Form WH-480-E in the English language or the language in which the business operates. The form must be signed and notarized.
10. Declaration of intention and purpose. Sign the original Form WH-480-E in the English language or the language in which the business operates.
11. Declaration of filing. Sign a copy of the original Form WH-480-E attached to the original document and attach 1 copy of the original passport.
12. Declaration of foreign law. Sign the original Form WH-480-E in the language of the business.
13. Declaration of business or family partnership.
How many people fill out Form WH-380-E each year?
Every year at least 2.7 trillion (2,731,078,813) requests for Social Security numbers are submitted. The number of Form WH-380-E applications, as of May 2015, was 2,713,844,015. The number of people who use that form each year:
1,064,064,845 (15%) are male.
1,088,547,611 (17%) are female.
2,731,078,813 individuals (23%) were between the ages of 0-17, and 473,567,719 individuals (25%) of those ages had attained age 17.
Are there more than 50 million people who apply for a Social Security number each year?
No. There are fewer than 50 million people who apply for a Social Security number each year.
In addition, in the first quarter of 2017, approximately 16 million individuals requested a Social Security number for the first time, in a non-traditional sense. Non-traditional is defined as a person who already has a Social Security account; has a child and is not yet divorced; and is not yet in a child custody proceeding.
What if something goes wrong during the number-request process?
Social Security Administration (SSA) will not disclose how many people are affected by any type of error during the Social Security number-request process. Any information related to the number-request process is confidential and must be protected by law. SSA will not disclose the identity of an individual who makes a number-request. Any information that could reveal a person's identity can prevent access to needed services or affect the processing of applications. If a person is a victim of identity theft, SSA may request that a person remove any or all identifying information from the Social Security Administration's report. You must submit a completed form WH-310 to SSA, or a request can be made through an online or telephonic communication at.
What if an individual does not complete the entire form WH-310.
If an individual does not complete all the items on Form WH-310, their application is considered incomplete. A portion of the completed form may be sent to SSA under the following conditions:
SSA must be notified of the missing information.
Is there a due date for Form WH-380-E?
Yes. All Forms must be filed by 11:59 p.m. on the date they appear on the forms. The due date for Form WH-377-E is the last day for filing it, which is the last day for tax returns to be filed by February 15.
When is Form WH-380-E and Form W-2G filed?
You must file Form WH-380-E by April 18, so it is due by the last day for filing for 2014 tax year.
How can I tell whether my Form WH-380-E should be filed by the due date?
The instructions give guidance at how to determine the due date for filing your Form WH-380-E. The instructions note that Form WH-380-E should be filed by the due date, but they also indicate that you can always try to file it on time.
If your Form is being filed after the due date, you have two options. You can either choose not to file a tax return or you can choose to file your return after the due date and pay the applicable penalties and fees. Remember that if you do not pay all the tax due by the due date, some or all of the remaining tax will be assessed to you at a later time. For example, if you owe 3,000 on your Form WH-380-E, you would choose to file it by the due date, but you would also owe interest (25 cents per 1,000) for the interest amount outstanding at the time the tax was due.
If Form WH-380-E is being filed late and is filed after the due date, interest is still assessed for the period the form was not filed until the due date. If you are paying some or all of the tax due for other reasons, such as because you are a disabled veteran, your disabled veteran tax benefits may be reduced or terminated. For more information check out the IRS Publication 575, Veterans Who Received a Tax Refund in a Paper or Electronic Form (Form W-2G, Electronic File of Tax Information; and Form W-2G-EZ, Electronic Tax Information). When should I file my Form or the IRS Tax Forms and Publications?
Forms you will pay tax on must be filed on the due date. Form 941, Federal Income Tax Return, is filed on the due date in addition to the return being filed.
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