What Information Do You Generally Need to Fill Out a Family Medical Leave Form?


Quick Answer

U.S. Department of Labor regulations allow employers to ask employees requesting family medical leave to provide information about their health care provider, a description of the medical condition and prognosis, or other reason for the request, and the amount of leave requested. Requiring a physician's signed statement is also allowable.

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Full Answer

Under the Family Medical Leave Act, the birth of a newborn, care of a newly placed foster or adopted child, care of a seriously ill spouse, child or parent, and one's own serious all illness entitle eligible employees to up to 12 weeks of unpaid leave per year, according to the U.S. Department of Labor. The act was amended in federal fiscal year 2008 to expand eligibility to those caring for active-duty military personnel who were injured or taken ill while serving, providing 26 weeks of allowable leave in a 12-month period. An amendment in 2010 provides coverage for eligible employees caring for veterans whose illnesses or injuries meet certain requirements. Continuous leave, intermittent leave, or a reduced schedule are options available under the Family Medical Leave Act.

The Family Medical Leave Act provisions, per the Department of Labor, Wage and Hour Division, apply to all public agencies and most employers in the private sector with 50 or more employees. Benefits are available to individuals who have been employed for 12 months, during which they worked at least 1250 hours.

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