FMLA Forms

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• FMLA - Core-CT Coding Form - FMLA-HR2c

  Form to be completed by agency human resources when the employee has been approved for family leave, medical leave or military family leave and is attached to the employee's HR2b - Designation Notice.

• FMLA - Employee's Intent to Return to Work Form - FMLA-HR-3

  Form to be completed by the employee indicating his/her intent to return to work prior to taking family leave, medical leave or military family leave.

• FMLA Agency Response Designation Notice - FMLA-HR-2b

  Form to be completed by agency human resources department notifying employee of the disposition of the employee's request for family leave, medical leave or military family leave.

• FMLA Agency Response Eligibility Notice to Employee - FMLA-HR-2a

  Form to be completed by agency human resources department notifying employee of his/her eligibility in response to employee's request for family leave, medical leave or military family leave.

• FMLA Caregiver Medical Certificate P-33B

  Form to be used by employees seeking family leave to care for a spouse, child, or parent with a “serious health condition". Form must be completed by family member's attending medical provider.

• FMLA Employee Medical Certificate P-33A

  Form to be used by employee who is absent for personal illness, including FMLA absences; form must be completed by employee's attending medical provider.

• FMLA Employee Request Form - FMLA-HR-1

  Form to be completed by employee requesting family leave, medical leave or military family leave.

• FMLA Statement of Qualifying Family Relationship FMLA-HR4

  For Family Leave or Military Family Leave