Form GBRIG-5 2026

See details

4.8 out of 5

29 votes

The document is Form GBRIG-5, a certification form for employees requesting military caregiver leave under the Family and Medical Leave Act (FMLA) due to a serious injury or illness of a covered veteran. It outlines the responsibilities of both the employee and employer regarding the submission of medical certifications, confidentiality requirements, and details necessary for validating the leave request. The form includes sections for employee information, veteran information, care to be provided, and health care provider input.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Form GBRIG-5 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open Form GBRIG-5 in the editor.
In Section I, provide your employer's name and address, along with your name and the veteran's name. Indicate your relationship to the veteran by checking the appropriate box.
Complete Part B by entering the veteran’s discharge date and answering whether they were dishonorably discharged. Provide details about their military branch, rank, and unit.
In Part C, describe the care you will provide to the veteran and estimate how much leave you will need for this care.
Once Section I is complete, ensure that a qualified health care provider fills out Section II. This includes providing their information and confirming the veteran's medical status.
Review all sections for accuracy before saving or printing the completed form. Remember not to send it to the Department of Labor; return it directly to your employer.

Start using our platform today for free to streamline your document editing and form completion!

See more Form GBRIG-5 versions

We've got more versions of the Form GBRIG-5 form. Select the right Form GBRIG-5 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (29 Votes)
2009	4 Satisfied (32 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who files form 5?

VETERANS BENEFITS VERIFICATION AND REFERRAL FORM CW 5 USE THE CW 5: 1. To verify the status amount of the veterans benefits being received. 2. To refer applicants or recipients to the County Veterans Service Office (CVSO).

What is a CW 5 form?

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE. The member must complete the form in its entirety, sign and date the form, and have it docHubd.

Can I fill out the SS-5 form online?

Form 5 collects the annual statement of changes in beneficial ownership of equity securities for (1) any director or officer of an issuer with a class of equity securities registered pursuant to Section 12 of the Securities Exchange Act of 1934 (Exchange Act); (2) any beneficial owner of greater than 10 percent of a