Family Medical Leave Act (FMLA) - Sample Letters

Summary: Sample letters for Family Medical Leave including pregnancy disaiblity leave, military caregiver, and parental leave.

  1. Employee Not FML Eligible — For All FML Requests except PDL (Pregnancy Disability Leave)

  2. Employee FML Eligible but Leave Entitlement Exhausted — For All FML Requests except PDL

  3. Employee FML Eligible — For Leave for Employee's Serious Health Condition

  4. Employee FML Eligible — For Leave for Family Member's Serious Health Condition

  5. Employee FML Eligible — For Military Caregiver Leave

  6. Employee FML Eligible — For Qualifying Exigency Leave

  7. Employee FML Eligible — For Parental Leave when Employee is not birth mother

  8. Employee FML Eligible — For Combined PDL and Parental Leave

  9. Employee Not FML Eligible — For Requests for PDL only

  10. Employee FML Eligible but Leave Entitlement Exhausted — For Requests for PDL only

  11. Employee FML Eligible — For Requests Limited to PDL

  12. Certification and/or Declaration Not Received — For all FML Leaves

  13. Certification Incomplete or Insufficient — For all FML Leaves

  14. Designation Letter — For All Approved and Denied FML Requests except Approved Requests for Combined PDL and Parental Leave

  15. Designation Letter — For Approved Combined PDL and Parental Leave

  16. PDL Confirmation Letter — Employee Not FML Eligible or Employee FML Eligible but Leave Entitlement Exhausted

  17. Letter for Change in End Date of PDL — For Approved Combined PDL and Parental Leave

  18. Re-certification — For Leave for Employee's or Family Member's Serious Health Condition


For more information refer to Family Medical Leave Act (FMLA) - for Supervisors.

Need an expert? Contact your Employee Relations Consultant in Human Resources.

Notice: University policies, procedures and applicable collective bargaining agreements shall supersede information in this document or elsewhere on this site.


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