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The Department has developed optional-use forms which can be used by employers to provide required notices to employees, and by employees to provide certification of their need for leave for an FMLA qualifying reason. These forms are electronically fillable PDFs and can be saved electronically.
Certification of Health Care Provider Form for FMLA. This form is required to certify an employee's serious health condition under the Family and Medical Leave Act (FMLA). It must be completed by a health care provider and returned to the employer. Ensure to submit the form within the stipulated time to avoid denial of leave.
The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave to care for a family member with a serious health condition to submit a medical certification issued by the family member’s health care provider. 29 U.S.C. §§ 2613, 2614(c)(3); 29 C.F.R. § 825.305. The employer must give the ...
The U.S. Department of Labor also has free, optional-use forms that may be used to certify an employee’s own serious health condition or an employee’s family member’s serious health condition. These forms, including instructions, can be found here along with more information on using the forms.
This page provides FMLA Information for HR Administrators. Please visit UCnet to find the following information and documents related to Family and Medical Leave resources, university policies, and contract provisions: For your convenience, here are the sample letters in Word format.
Use these forms when requesting a FMLA leave. Family Care & Medical Leave (CFRA) and Pregnancy Disability Leave (PDL) (English) Family Care & Medical Leave (CFRA) and Pregnancy Disability Leave (PDL) (Spanish)
Our template is designed to capture all these essential details, aiding in a smooth FMLA leave request process. For your convenience, our FMLA Request Form is readily available in Word, PDF, and Google Docs formats.
