FMLA Application Forms

Updated 01-17-12

Please use these forms for applying for FMLA, rather than the carrier's forms. Download the form you need and print it out.


Medical Provider Form  - Employee Serious Health Condition
Medical Provider Form  - Family Member Serious Health Condition
Notice of Medical Rights & Responsibilities
Certification of Qualifying Exigency for Military Family Leave
Certification for Serious Injury or Illness of Covered Service Member - For Military Family Leave
FML Fact Sheet 2009
FML Act Info


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