Massachusetts Record of Absence - Self-Certification Form

State:
Multi-State
Control #:
US-457EM
Format:
Word; 
Rich Text
Instant download

Description

This Employment & Human Resources form covers the needs of employers of all sizes.
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FAQ

The FMLA is a federal labor law that guarantees up to 12 weeks during the year of job-protected leave to take care of a health condition that you or an immediate family member is facing, or to bond with a new child.

Generally no, you are not eligible for unemployment benefits if you take medical leave under the Family and Medical Leave Act and you cannot work.

According to the FMLA, your employees can take up to 12 weeks off in a 12-month period if they have already worked for 1,250 hours. Under the EFMLA, your employee only needs to have worked 30 days before being eligible.

Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.

If you are applying for military-related paid family leave benefits, or if you are currently self-employed or unemployed, please call the Department's Contact Center at (833) 344-7365 to begin your application.

You may not be eligible for Unemployment Insurance (UI) benefits if your only source of employment is from working as: An employee of a non-profit or religious organization. A worker trainee in a program run by a nonprofit or public institution. A real estate broker or insurance agent who work only on commission.

Claimants who are on a leave of absence granted at their request will be considered not in unemployment and therefore ineligible for UI benefits during the period of their leave.

If you quit your job because of domestic violence, or for other personal reasons that are urgent and compelling and made it necessary to quit, you will remain eligible for benefits.

An FMLA leave allows employees to take up to 12 weeks off in a 12-month period. If their absence is not protected by the Family and Medical Leave Act (FMLA), then it's considered a non-FMLA medical leave. However, their leave may still be protected under the ADA and ADA Amendments Act (ADAAA).

Employer Responsibilities To calculate their total contribution, Massachusetts employers should first determine their average annual workforce. There are no contributions to collect or make under FMLA, since it is not a paid benefit.

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Massachusetts Record of Absence - Self-Certification Form