FML Notification Sample Letter

[Date]

[Employee Name] [Address]

Dear [Employee Name]

The university provides Family and Medical Leave (FML) to eligible faculty and staff for up to 12 workweeks (480 hours) of leave during a 12 month period based on qualifying events, in accordance with federal law. Eligible faculty and staff that care for servicemembers are eligible for up to 26 workweeks of leave in a single 12 month period.

It has come to my attention that you may need leave under the Family Medical Leave Act (FMLA). Because of this, I am sending you the following information related to the Family and Medical Leave Policy:

 Application for Leave, hr.osu.edu/forms/appleave.pdf , or eLeave request, eleave.osu.edu  Medical Certification of Health Care Provider for Employee’s Serious Health Condition, hr.osu.edu/forms/ben/fmlcertee.pdf , or  Medical Certification of Health Care Provider for Family Member’s Serious Health Condition, hr.osu.edu/forms/ben/fmlcertfam.pdf  Employees Rights and Responsibilities under the FMLA, hr.osu.edu/hrpubs/FMLAPoster.pdf  Notice of Eligibility and Rights and Responsibilities, hr.osu.edu/forms/ben/fmlnoticer&r.pdf

The Family and Medical Leave Policy 6.05 can be found at hr.osu.edu/policy/policy605.pdf and the Frequently Asked Questions about the policy may be found at hr.osu.edu/hrpubs/familyleave605faq.pdf.

Family Medical Leave may be taken all at once or intermittently as approved, once eligibility requirements have been established. Intermittent leave may be taken at hourly, daily, or at weekly intervals. Arrangements for intermittent leave must be coordinated with your supervisor.

As outlined in the attached documents, besides meeting eligibility requirements, you must also complete the Application for Leave/eLeave request and return the completed Medical Certification form:

 Application for Leave, hr.osu.edu/forms/appleave.pdf , or eLeave request, eleave.osu.edu  Medical Certification of Health Care Provider for Employee’s Serious Health Condition, hr.osu.edu/forms/ben/fmlcertee.pdf, or  Medical Certification of Health Care Provider for Family Member’s Serious Health Condition, hr.osu.edu/forms/ben/fmlcertfam.pdf

These completed forms must be returned to [unit HR contact] either by U. S., campus, or e-mail [e-mail address], or faxed to [fax number] no later than 15 calendar days after receipt of this letter. You must return a completed Medical Certification of Health Care Provider for Employee’s Serious Health Condition or Medical Certification of Health Care Provider for Family Member’s Serious Health Condition for your leave request to be approved under the Family and Medical Leave Policy. Medical Certifications that are incomplete cannot be processed and will be returned for further information. Once the above documentation is received, your leave will be counted toward your annual Family and Medical Leave entitlement if it meets the criteria under the policy.

If you have questions regarding this matter, please contact me at [xxx-xxx-xxxx].

Sincerely, [Signature of unit HR contact] [Unit HR name] Updated 11/19/2011