Medical and family leave

Care for yourself and your family

Family and medical leave (FML) helps you focus on what matters most when you need to temporarily shift attention from your job to take care of yourself or a family member.

As an employee of the State of Connecticut, you may be eligible for any of the following family and medical leave entitlements:

Federal FMLA
CT FMLA
SEBAC Supplemental Leave
Pregnancy Disability Leave
Organ Donor Leave
Bone Marrow Donor Leave

These leaves allow you to balance your work and family responsibilities while taking job-protected leave for certain family and medical reasons. Read below for more information about these leaves, how to begin the process, and more.

Important resources

The following policies and guidelines provide State employees and human resource professionals with information about the family and medical leave entitlements available.

DAS general letter 39 – FML entitlements (PDF)

This letter outlines the policies and procedures in place when an employee seeks family or medical leave.

Family and Medical Leave Entitlements Manual

Manual to assist HR professionals responsible for administering family and medical leave entitlements.

Federal Department of Labor FMLA Poster

U.S. Department of Labor poster summarizing the major provisions of the Family and Medical Leave Act (FMLA).

CT Department of Labor CTFMLA & CTPL Poster

CT Department of Labor poster summarizing employee rights under the CT Family and Medical Leave Act (CTFMLA) and the CT Paid Leave Act (CTPL).

Pregnancy Discrimination and Accommodation Notice

CT Department of Labor notice informing employers of their obligations under CT General Statutes §§ 46a-60(a), (b)(7), (d)(1).

Getting started: employee responsibilities

Contact agency HR

Do you need to take job-protected leave for medical or family reasons? The first thing you should do is contact your agency human resources liaison for leave administration:

If you work for a State of Connecticut executive branch agency participating in HR Centralization, start your request in the UKG Employee Portal or contact the appropriate DAS Benefits and Leaves Pod assigned to your agency.

If your agency isn’t in the executive branch or you aren’t sure, please contact your agency’s human resources office.

Standard family and medical leave

Personal medical leave: Leave for an employee who has their own illness or injury; any period of incapacity due to their pregnancy or prenatal care; the donation of an organ; or the donation of bone marrow.

Caregiver leave: Leave for an employee whose family member has a serious health condition.

Bonding leave: Leave for an employee to: bond with a newborn child; process the adoption or bond with a newly adopted child; or process the placement of, or bond with, a newly placed foster child.

Forms for standard leave

These forms provide you with information, help us better understand your leave needs, and grant us permission to use your accruals during your unpaid leave if desired. Use them to request job-protected leave for your own serious health condition, as a caregiver to a qualified individual with a serious health condition, or for bonding leave.

Employee Request Form: FMLA-HR-1

Use this form to request family leave, medical leave, or military family leave.

Employee's Intent to Return to Work: Form FMLA-HR-3

When applying for leave, complete this form to show you plan to return to work.

Statement of Qualifying Family Relationship: Form FMLA-HR4

Use this form to document your relationship to the person you’ll provide care for.

Employee Medical Certificate: Form P-33A

This medical certificate should be completed by the employee and their medical provider when the employee is applying for a medical leave for themselves.

Caregiver Medical Certificate: Form P-33B

This medical certificate should be completed when an employee is requesting leave to care for a family member with a serious health condition in conjunction with the family member's medical provider.

Military caregiver and exigency leave

Caregiver for current service member: Leave for an employee whose spouse, son, daughter, parent, or next of kin has a serious injury or illness while on covered active duty.
Caregiver for a veteran: Leave for an employee whose spouse, son, daughter, parent, or next of kin is a covered veteran who incurred a serious injury or illness while on covered active duty.
Qualifying exigency leave: Leave for an employee due to a “qualifying exigency” because their spouse, son, daughter, or parent is on covered duty. See DAS General Letter 39 (PDF) for specifics.

Forms for military caregiver and exigency leave

These forms provide you with information, help us better understand your leave needs, and grant us permission to use your accruals during your unpaid leave if desired. Complete them when you apply for job-protected leave to care for someone who is in the military or a veteran or to prepare for the sudden activation of a service member.

Military Exigency Request: Form WH-385

Use this to apply for leave because of the foreign deployment of your spouse, son, daughter, or parent.
Medical Certificate for Current Military Family Member: Form WH-385

Use this form when you apply for leave to care for a covered veteran with a serious illness or injury.
Medical Certificate for Veteran Family Member: Form WH-385V

Used to apply for leave to care for a family member who is a covered veteran with a serious injury or illness.
Statement of Qualifying Family Relationship: Form FMLA-HR4

Use this to document your relationship to the person you’ll provide care for.

After you apply: human resources responsibilities

How HR follows up

HR will review the forms you provided and will notify you of your eligibility for job-protected leave as well as your rights and responsibilities. If approved, HR will:

Send the approval coding to you and your manager/supervisor
Coordinate your leave processing with payroll/benefits

If your request is not approved, HR will issue a denial with supporting justification.

Please contact your HR leave specialist with any questions.

Forms for HR use

Notice of Eligibility and Rights and Responsibilities: Form FMLA-HR2a

HR completes this form to tell employees if they’re eligible for family or medical leave.

Designation Notice: Form FMLA-HR2b

HR uses this form to tell employees about what they’re entitled to, their leave responsibilities, and accrual usage.

Core-CT Coding: Form FMLA-HR2c

Complete this form to tell employees their approved time frame and the Core-CT codes they should use while on leave.

The Supervisor's role

How to help the process

Supervisors are important partners in the leave process. They are often the first to know that an employee may have a qualifying reason for family or medical leave. Supervisors are responsible for:

Contacting Human Resources as soon as possible even if employees don’t specifically use the term “FMLA.”
Reminding employees to follow agency call-out procedures while their leave approvals are pending and ensure employees are properly coding their time sheet once leaves are approved.
Tracking an employee’s leave usage to make sure they aren’t overusing their approved leave and communicate any usage concerns to HR.

Supervisors don’t accept medical documents or contact medical providers directly.

Additional resources

It is important to understand that family and medical leave entitlements vary by circumstance. We encourage employees and HR professionals to use our resources before deciding or providing guidance about family and medical leave or related benefits. These resources include: