Benefits
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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.
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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.
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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.
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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.
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FMLA Employee Request Form - FMLA-HR-1
Form to be completed by employee requesting family leave, medical leave or military family leave.
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FMLA Statement of Qualifying Family Relationship FMLA-HR4
For Family Leave or Military Family Leave