Human Resources Business Rules and Regulations
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FMLA - Military Family Leave - Med Certificate for Military Family Member - WH-385
Form to be completed by an agency, employee and then health care provider when an employee requests leave under the FMLA to care for a family member who is a current member of the Regular Armed Forces, the National Guard, or the Reserves who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list for a serious injury or illness.
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FMLA - Military Family Leave - Med Certificate for Veteran Family Member - WH-385V
Form to be completed by an employee and then health care provider when the employee seeks military caregiver leave under the FMLA leave due to a serious injury or illness of a covered veteran; this certification must provide sufficient facts to support the request for leave.
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FMLA Agency Response Designation Notice - FMLA-HR-2b
Form to be completed by agency human resources department notifying employee of the disposition of the employee's request for family leave, medical leave or military family leave.
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FMLA Agency Response Eligibility Notice to Employee - FMLA-HR-2a
Form to be completed by agency human resources department notifying employee of his/her eligibility in response to employee's request for family leave, medical leave or military family leave.
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FMLA Caregiver Medical Certificate P-33B
Form to be used by employees seeking family leave to care for a spouse, child, or parent with a “serious health condition". Form must be completed by family member's attending medical provider.
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FMLA Employee Medical Certificate P-33A
Form to be used by employee who is absent for personal illness, including FMLA absences; form must be completed by employee's attending medical provider.
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FMLA Employee Request Form - FMLA-HR-1
Form to be completed by employee requesting family leave, medical leave or military family leave.
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FMLA Statement of Qualifying Family Relationship FMLA-HR4
For Family Leave or Military Family Leave
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Forms Approval Process - Comptroller Memorandum No. 2002-09 - March 28, 2002
Approval process for agencies to change forms to mirror Comptroller forms
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Grievance and Appeal to the Office of Labor Relations - PER-144
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The Appendix lists all state job classifications which have been designated as covered under the hazardous duty provisions of the State Employees Retirement System.
