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Family and Medical Leave Sample Letters

For your convenience, here are the sample letters in Word format.

  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
Contact Employee Relations, (858) 534-4115. For UC San Diego Health Science Employees, please call 619-543-3200.