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FMLA Forms


F.M.L.A.

Family Medical Leave Act

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The following is a ready reference for APWU members to use in applying their rights under the Family and Medial Leave Act (FMLA). You are advised to follow these procedures and insist that local management afford you all of your entitlements under the law.

Employee’s Obligation

1. Provide 30-day advance notification when leave is foreseeable.

2. Notify as soon as practicable when leave is not foreseeable.

3. Make management aware that absence was or will be due to a serious health condition, childbirth, newborn childcare, and placement in foster care or adoption. Your notice must be within 1 or 2 business days of learning the need for leave, but no later than 2 business days upon return to work. Notice must be sufficient to make management aware that condition qualified as FMLA under the Law. Notice that you are/were sick is not sufficient notice.

4. When circumstances justifying FMLA have not been provided by you prior to the taking of leave, ensure that management has sufficient information, during or within 2 days following the absence. Your designation of the leave as FMLA, while not required, will satisfy your notice requirement pending further inquiry by management.

5. Your completion of APWU form #1 may serve as notice of an absence covered by FMLA and/or as your certification of a covered FMLA condition pending management's written request for medical certification.

6. Complete Form 3971 for payment of requested leave, limiting your response to "request for leave only." Notice of FMLA absence should be made verbally or on APWU Form #1, with your signature. If absence is for family member, insert their name on APWU Form #1. When responding to request for medical documentation, use appropriate APWU form, signed by health care provider.

7. Medical documentation should be provided only upon written request from management. Use APWU form and have physician respond to all relative questions. If documentation contains a diagnosis or prognosis, you may insist that its access should be limited to postal medical personnel.

8. Promptly inform management of any changes to FMLA condition.

9. Prior to return to duty, you may be required by written notice to present a certificate from your health care provider that you are able to return to work. (After your return, you may be required to submit to a fitness for duty.) Your return to duty may not be delayed if you have provided prior notice of your date of return.

10. If your absence is due to your chronic condition, which you have documented by submitting a completed APWU form (and you have not been referred to a USPS physician), intermittent or reduced schedule absences related to the condition are certified by your completion of the appropriate APWU form. No subsequent medical documentation is required prior to the next scheduled doctor's visit unless there is a change in your condition.

Managements Obligation

Post Form WH Publication 1420 or Form with same information in your facility where it will come to the attention of all employees, advising them of their rights under FMLA. The form must remain posted at all times.

Upon being made aware that your absence is due to an FMLA condition (yours or a family member), management must:

  • Notify you of eligibility prior to the date leave starts. If your notice of leave is less than 2 business days prior to start of leave, supervisor has 2 days from your notice to determine and notify of eligibility.
  • Provide you with a copy of USPS Publication 71.
  • Provide in writing to you:
  • Specific expectations and obligations of you, including request for medical documentation and any consequences of a failure to meet these obligations. A supervisor's notation (Medical documentation requested) on Form 3971 will satisfy notice requiring documentation.
  • That the leave will be counted against your 12-week entitlement. (You may inform orally, but it must be confirmed in writing no later than the following payday.) Supervisor's notation of FMLA on Form 3971 is sufficient if completed form is returned to you.
  • Inform whether or not management will require the substitution of paid leave for the absence and any consequences for such substitution.
  • Any requirement for you to make any premium payments to maintain health benefits and the arrangement for making payments.
  • Any requirement for you to present a fitness-for-duty certificate to be restored to duty.
  • Your right to restoration to the same or equivalent position.
  • If a written request is made for medical documentation and you submit a complete certification signed by the health care provider, management may not request additional medical information. If there are further questions, a health care provider representing USPS may contact your provider with your permission, for purposes of clarification.
  • If management questions the adequacy of your medical certification even though you have submitted a complete certification, they are limited to referring you to a USPS designated physician for a second opinion. (No additional information may be required and your supervisor/manager may not contact your physician.)

You should follow all instructions from your supervisor and provide all information requested. If the provisions outlined above are violated you should contact your union representative and initiate an appeal using the APWU appeals process, requesting compensation for all losses and expenses incurred, including damages equal to your expenses and losses associated with the violation.

Family and Medical leave should not be abused. Absences that do not qualify under the law should be covered under the normal USPS leave policy.

Prepared by: William Burrus, Executive Vice President, American Postal Workers Union, AFL-CIO

FMLA Forms
(Adobe Acrobat® Format)

APWU Form 1 Employee Certification of Own Serious Illness - FMLA
APWU Form 2 Certification by Employee's Health Care Provider for Employee's Serious Illness - FMLA
APWU Form 3 Health Care Provider Certification of Employee's Family Member Illness - FMLA
APWU Form 4 Notice of Need for Intermittent Leave or for a reduced work schedule - FMLA
APWU Form 5 Desired or Needed Absences for Birth or Placement of Son or Daughter Under FMLA