This form is an application for Family and Medical Leave. It is to be filled out by an employee who is requesting a leave of absence.
Printable Fmla Forms Massachusetts
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US-AHI-200
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How to fill out Employee Application For FMLA?
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FAQ
FMLA provides up to 12 weeks of job-protected, unpaid leave in a calendar year for family or medical reasons, or up to 26 weeks of job-protected, unpaid leave in a calendar year to care for a family member in the armed services. Employers are not required to pay employees taking FMLA leave.
Under the FMLA, an employee may use 12 weeks of unpaid leave within a year for certain family and medical leaves. The FMLA permits different methods to calculate when an employee reaches that 12 week limit.
Dear (Supervisor / HR Manager): Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave.
While the federal FMLA applies to employers with 50 or more employees, the PFML law covers all employers with just one or more employees. This means that many employees of small businesses that would not be covered under FMLA due to employer size are covered under PFML.
Notify your employer Try to provide at least 30 days notice before your official start date, if possible. Then, you can create an account on paidleave.mass.gov and apply online. If you're applying for military-related leave, or unemployed, please call the Department's Contact Center at (833) 344-7365 to get started.