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.
  1. Employee Not FML Eligible - For All FML Requests except PDL
  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 & 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. Recertification - For Leave for Employee' or Family Member's Serious Health Condition