FMLA: Guidelines, Forms, and Sample Letters

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:

  • Family and Medical Leave - Key Information:
    • FML Guidelines - a step-by-step guide to administer routine FML requests and pregnancy disability leave (PDL) requests
    • Notices
    • Certifications
    • Additional resources (forms, checklists and facts)
  • Sample Letters:
    FMLA sample letters, created by UCnet, are currently available in PDF format on the UCnet website. For your convenience, here are the sample letters in Word format. Note: these letters belong to UCnet - please consult the UCnet website for the most up-to-date information. If you have any questions about the use of these letters, please contact your Employee Relations Consultant.

For Staff

  1. Employee Not FML Eligible - For All FML Requests 
  2. Employee FML Eligible but Leave Entitlement Exhausted - For All FML Requests 
  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. Recertification - For Leave for Employee' or Family Member's Serious Health Condition

For Pregnancy Disability Leave (PDL)

  1. Employee FML Eligible - For Combined PDL and Parental Leave
  2. Employee Not FML Eligible - For PDL only
  3. Employee FML Eligible but Leave Entitlement Exhausted - For PDL only
  4. Designation Letter - For Approved Combined PDL and Parental Leave
  5. PDL Confirmation Letter - Employee Not FML Eligible or Employee FML Eligible but Leave Entitlement Exhausted
  6. Letter for Change in End Date of PDL - For Approved Combined PDL and Parental Leave

For All

  1. Certification and/or Declaration Not Received - For all FML Leaves
  2. Certification Incomplete or Insufficient - For all FML Leaves
  3. Designation Letter - For All Approved and Denied FML Requests except Approved Requests for Combined PDL & Parental Leave

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