Family and Medical Leave Sample Letters
Last Updated: May 17, 2021 2:30:15 PM PDT
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For your convenience, here are the sample letters in Word format.
- Employee Not FML Eligible - For All FML Requests except PDL
- Employee FML Eligible but Leave Entitlement Exhausted - For All FML Requests except PDL
- Employee FML Eligible - For Leave for Employee's Serious Health Condition
- Employee FML Eligible - For Leave for Family Member's Serious Health Condition
- Employee FML Eligible - For Military Caregiver Leave
- Employee FML Eligible - For Qualifying Exigency Leave
- Employee FML Eligible - For Parental Leave (when Employee is not Birth Mother)
- Employee FML Eligible - For Combined PDL and Parental Leave
- Employee Not FML Eligible - For Requests for PDL only
- Employee FML Eligible but Leave Entitlement Exhausted - For Requests for PDL only
- Employee FML Eligible - For Requests Limited to PDL
- Certification and/or Declaration Not Received - For all FML Leaves
- Certification Incomplete or Insufficient - For all FML Leaves
- Designation Letter - For All Approved and Denied FML Requests except Approved Requests for Combined PDL & Parental Leave
- Designation Letter - For Approved Combined PDL and Parental Leave
- PDL Confirmation Letter - Employee Not FML Eligible or Employee FML Eligible but Leave Entitlement Exhausted
- Letter for Change in End Date of PDL - For Approved Combined PDL and Parental Leave
- Recertification - For Leave for Employee' or Family Member's Serious Health Condition
Contact Employee Relations, (858) 534-4115. For UC San Diego Health Science Employees, please call 619-543-3200.