FMLA Company Response (Designation) with Tip Sheet - ComplyRight

Form Template

Use this attorney-developed form to help satisfy government requirements by providing employees the FMLA-related information they need after an FMLA request is made.

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Updated to comply with the most recent FMLA regulations effective March 8, 2013

The form notifies employees whether their leave will be designated and counted as FMLA leave. It should be used as soon as an employer has enough information to determine whether an employee’s leave is being taken for an FMLA-qualifying reason (e.g., after receiving a certification). The form should be completed and provided to employees within five business days from the time an employer acquires enough information to determine whether the employee’s leave is being taken for an FMLA-qualifying reason. Click here for a free tip sheet that includes guidelines to ensure accurate completion of the form, relevant FMLA definitions, and helpful do’s and don’ts. There are two Company Response forms that employers are required to provide to employees so employers should also see our FMLA Company Response (Eligibility) and Tip Sheet.

Need printed FMLA Forms? Visit G.Neil for a printed version of the FMLA Company Response (Designation) Form.

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