Wayne Michigan FMLA Certification of Physician

State:
Multi-State
County:
Wayne
Control #:
US-AHI-202
Format:
Word
Instant download

Description

This AHI form is used by employers who have an employee that has requested medical leave. This form is filled out by the physician of the person that is being treated.
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FAQ

Call the MI HR Service Center within 31 days of the birth or adoption at 877-766-6447, option 1. Fax a copy of birth certificate to the MI HR Service Center at 517-241-5892.

To be eligible for FMLA, you must have 12 months of employment with the State of Michigan (does not need to be consecutive) and you must have physically worked 1,250 hours within the previous 12 months. For questions on FMLA eligibility, contact the Disability Management Unit (DMU) by phone at 877-443-6362.

USPS Moves Processing of Employees FMLA Requests to Human Resources Center HeadquartersPO Box 970909Greensboro, NC 27497-0909FAX: 651-456-6067Western40 more rows ?

How to File a Paid Family Leave (PFL) Claim by Mail Visit Online Forms and Publications and order a form online. A form will be mailed to you. Obtain the form from your physician/practitioner or employer. Visit an SDI Office. Call 1-877-238-4373. California Relay Service (711) Provide the PFL number (1-877-238-4373)

Benefits Provided Paid family and medical leave provides Massachusetts employees with up to 12 weeks of job-protected, paid family leave, up to 20 weeks of job-protected, paid medical leave, or up 26 weeks of combined family and medical leave in a benefit year.

To be eligible for FMLA benefits, an employee must: work for a covered employer; have worked for the employer for a total of 12 months; have worked at least 1,250 hours over the previous 12 months; and. work at a location where at least 50 employees are employed by the employer within 75 miles.

29 C.F.R. § 825.313. Information about the FMLA may be found on the WHD website at . Either the employee or the employer may complete Section I.

Though the FMLA itself is unpaid, it is sometimes possible under certain specific circumstances to use paid leave that you've accrued on the job as a way to get paid during your FMLA leave. The types of paid leave that might be considered include vacation days and sick days, as well as other types of paid leave.

To apply for a medical leave of absence: Submit your application: Online, or. Print, complete and fax an Application for Leave of Absence. Have your treating physician complete one of the following: FMLA Certification of a Serious Health Condition, or. Non-FMLA Medical Certification. Not sure if you qualify under the FMLA?

Although FMLA leave is unpaid, employees may be allowed (or required) to use their accrued paid leave during FMLA leave. When an employee's FMLA leave ends, the employee is entitled to be reinstated to the same or an equivalent position, with a few exceptions.

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Wayne Michigan FMLA Certification of Physician