EMPLOYEE LEAVE NOTIFICATION LETTERS
Download and customize the attached letters for leave administration under the Family and Medical
Leave Act (FMLA):
Leave Eligible Notification
Leave Denial Notification
Leave Denial, FMLA Exhausted Notification
Leave Eligible, Care for Family Member Notification
Leave Eligible, Military Caregiver Notification
Leave Eligible, Qualifying Exigency Notification
Leave Eligible, Parental Bonding Leave Notification
Leave Eligible, Pregnancy Disability and Parental Bonding Leave Notification
Leave Eligible, Pregnancy Disability Leave Notification
Leave Denial, FMLA Exhausted; Pregnancy Disability Leave Eligible Notification
FMLA Leave Ineligible; Pregnancy Disability Leave Eligible Notification
Notification, Certification Not Received
Notification, Certification Incomplete
Leave Approval
Leave Approval, Pregnancy Disability and Parental
Leave Approval, Pregnancy Disability
Leave Date Change, Pregnancy Disability
Recertification Request
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA leave due to your own serious health condition.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification of Health Care Provider for Employee’s Serious Health Condition (to be
completed by your physician).
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form. All forms must be
returned within 15 days of receipt of this letter for your leave to be processed timely and under FMLA
protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification of Health Care Provider for Employee’s Serious Health Condition (with Job
Description)
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Denial Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. Regretfully, we are informing you that you are not currently eligible for leave due
to the eligibility requirements not yet being met as outlined in our attached policy and/or Notice of
Eligibility and Rights and Responsibilities.
You may want to consider a non-FMLA-qualified or personal leave of absence as applicable to our other
leave policies. If you have questions you may refer to our Employee Handbook, or call [NAME] at
[PHONE NUMBER]. You may submit a newly completed Leave of Absence form (also attached) selecting
the appropriate leave you wish to have considered.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Denial, FMLA Exhausted Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that while you are eligible for
family and medical leave, you have already exhausted your entitlement for this leave year.
You may want to consider a non-FMLA-qualified or personal leave. You may review these leave options
in our Employee Handbook or call [NAME] at [PHONE NUMBER] to better understand your options. If
interested in requesting a different leave, please complete and submit a Leave of Absence Request
form.
Attached you will find:
Leave of Absence Request.
Designation Notice.
Notice of Eligibility and Rights and Responsibilities.
If you have any questions, please contact [NAME] at [PHONE NUMBER].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Designation Notice
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible, Care for Family Member Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA-qualified leave in order to care for a family member with a serious health condition.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Declaration of Relationship.
Certification of Health Care Provider for Family Member’s Serious Health Condition.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form. You will need to
have your family member’s physician complete the Certification document. All forms must be returned
within 15 days of this request for your leave to be processed timely and under FMLA protection. Remit
all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Declaration of Relationship
Certification of Health Care Provider for Family Member’s Serious Health Condition
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible, Military Caregiver Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA-qualified leave in order to care for a covered service member.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification for Military Caregiver Leave.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form. You will need to
have the covered service member’s physician complete the Certification document. All forms must be
returned within 15 days of this request for your leave to be processed timely and under FMLA
protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification for Military Caregiver Leave
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible, Qualifying Exigency Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA-qualified leave in order to deal with one or more qualifying exigencies regarding a covered
service member.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification for Qualifying Exigency Leave.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form and Certification for
Qualifying Exigency Leave. All forms must be returned within 15 days of this request for your leave to be
processed timely and under FMLA protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification for Qualifying Exigency Leave
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible, Parental Bonding Leave Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA-qualified leave for parental bonding and to care for your newborn child.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Declaration of Relationship.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form and Declaration of
Relationship form. All forms must be returned within 15 days of this request for your leave to be
processed timely and under FMLA protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Declaration of Relationship
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible, Pregnancy Disability and Parental Bonding Leave Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA-qualified leave due to a disability resulting from your pregnancy, childbirth, or related medical
condition, as well as parental bonding leave to care for your newborn child.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification of Health Care Provider for Employee’s Pregnancy Disability.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form and have your
physician complete the Certification of Health Care Provider for Employee’s Pregnancy Disability form.
All forms must be returned within 15 days of this request for your leave to be processed timely and
under FMLA protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification of Health Care Provider for Employee’s Pregnancy Disability
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Eligible, Pregnancy Disability Leave Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are currently eligible
for FMLA-qualified leave due to a disability resulting from your pregnancy, childbirth, or related medical
condition.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification of Health Care Provider for Employee’s Pregnancy Disability.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to both Part A and B.
If you have not done so already, please complete a Leave of Absence Request form and have your
physician complete the Certification of Health Care Provider for Employee’s Pregnancy Disability form.
All forms must be returned within 15 days of this request for your leave to be processed timely and
under FMLA protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification of Health Care Provider for Employee’s Pregnancy Disability
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Denial, FMLA Exhausted; Pregnancy Disability Leave Eligible Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that while you are eligible for
family and medical leave, you have already exhausted your entitlement for this leave year. However, you are
entitled to a leave for a disability resulting from your pregnancy, childbirth, or related medical condition.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification of Health Care Provider for Employee’s Pregnancy Disability.
Designation Notice.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to the eligibility rights so you understand why you are not currently eligible for
FMLA.
If you have not done so already, please complete a Leave of Absence Request form and have your
physician complete the Certification of Health Care Provider for Employee’s Pregnancy Disability form.
All forms must be returned within 15 days of this request for your leave to be processed timely and
under FMLA protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification of Health Care Provider for Employee’s Pregnancy Disability
Designation Notice
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding FMLA Leave Ineligible; Pregnancy Disability Leave Eligible Notification
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We are in receipt of your request for leave qualified under the Family and Medical Leave Act (FMLA)
submitted on [DATE]. After reviewing your request, we are informing you that you are not currently
eligible for FMLA-qualified leave. However, you are entitled to a leave for a disability resulting from your
pregnancy, childbirth, or related medical condition.
Attached you will find:
Leave of Absence Request (if the form has not yet been submitted).
Certification of Health Care Provider for Employee’s Pregnancy Disability.
Notice of Eligibility and Rights and Responsibilities.
It is important that you review the Notice of Eligibility and Rights and Responsibilities in its entirety,
paying close attention to the eligibility rights so you understand why you are not currently eligible for
FMLA.
If you have not done so already, please complete a Leave of Absence Request form and have your
physician complete the Certification of Health Care Provider for Employee’s Pregnancy Disability form.
All forms must be returned within 15 days of this request for your leave to be processed timely and
under FMLA protection. Remit all forms to [NAME] via [ENTER METHOD].
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Leave of Absence Request
Certification of Health Care Provider for Employee’s Pregnancy Disability
Notice of Eligibility and Rights and Responsibilities
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Notification, Certification Not Received
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We provided you with a letter dated [ENTER DATE] defining your leave status and requesting that you
submit additional information supporting your request for leave qualified under the Family and Medical
Leave Act (FMLA) for [STATE REASON]. At that time, we requested that you complete and return the
following document(s):
[CERTIFICATION FORM TITLE].
[OTHER FORM TITLE].
We are contacting you because as of the date of this letter, we have not received the aforementioned
document(s), nor have we received a reason for the delay. Your leave remains unapproved until such
time that documentation is received in its entirety and properly reviewed.
Attached you will find [NAME DOCUMENTS], which must returned within seven calendar days from the
date of this letter to [NAME] via [METHOD]. Unless and until the required documentation is received in
completion, your absences will not be designated as FMLA-qualified leave. Please understand that
without this designation, any absences taken are not protected under the FMLA and risk being
considered unapproved.
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: [LIST ALL DOCUMENTS BEING REQUESTED]
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Notification, Certification Incomplete
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
We provided you with a letter dated [ENTER DATE] defining your leave status and requesting that you
submit additional information supporting your request for leave qualified under the Family and Medical
Leave Act (FMLA) for [STATE REASON]. The certification you provided is not complete/sufficient as
stated below:
[CERTIFICATION FORM TITLE — DESCRIBE ISSUE OR AREA NEEDING COMPLETION].
[OTHER FORM TITLE — DESCRIBE ISSUE OR AREA NEEDING COMPLETION].
Please return the completed form(s) to [NAME] via [METHOD] no later than seven days from the date of
this letter. Unless and until the required documentation is received in completion, your absences will
not be designated as FMLA-qualified leave. Please understand that without this designation, any
absences taken are not protected under the FMLA and risk being considered unapproved.
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: [LIST ALL DOCUMENTS BEING REQUESTED]
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Approval
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
Enclosed is the Designation Notice related to your request for a request for leave qualified under the
Family and Medical Leave Act (FMLA). This notice will identify the status of your request and provide
information about other matters that may be related to your leave, such as your leave schedule and any
required return-to-work certification. It is important that you review this notice in its entirety.
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Designation Notice
Return-to-Work Certification (RWC), if required
Job Description, if required for RWC listing essential functions, if applicable
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Approval, Pregnancy Disability and Parental
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
Attached you will find a Designation Notice in support of your request for leave qualified under the
Family and Medical Leave Act (FMLA) due to a disability resulting from your pregnancy, childbirth, or
related medical condition, and parental leave to care for your newborn child. This notice identifies the
status of your request. This notice also addresses your other pertinent information such as your leave
schedule. Please review the notice in its entirety.
Your health care provider has indicated a beginning leave date of [ENTER DATE], and leave is anticipated
to have a probable duration of [NUMBER OF WEEKS], as indicated on your submitted certification.
Therefore it is assumed that your pregnancy disability leave portion of the overall leave will end on
[DATE]. As a result, on [DATE], your leave will be reclassified as parental leave. Because you have
requested [NUMBER OF WEEKS] of parental leave, your entire leave will end on [DATE], and your return
to work date is set as [DATE].
In the event that your pregnancy disability extends beyond the date specified above, you must let us
know as soon as possible. Upon notification, another Certification of Health Care Provider for
Employee’s Pregnancy Disability will be sent to you, which you will need to have completed and
returned to support your request for additional pregnancy disability leave.
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Designation Notice
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Approval, Pregnancy Disability
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
This is to confirm that you are approved for pregnancy disability leave beginning on [DATE] and ending
on approximately [DATE]. Your return to work date will therefore be [DATE]. If you need additional leave
time due to a disability resulting from your pregnancy, childbirth, or related medical condition, please
contact [NAME] at [PHONE NUMBER] as soon as reasonably possible.
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Leave Date Change, Pregnancy Disability
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
Thank you for providing the updated certification reflecting the new end date of the pregnancy disability
portion of your leave qualified under the Family and Medical Leave Act (FMLA). Based on the new
information, we are enclosing an updated Designation Notice.
As a result, we will assume that the pregnancy disability leave portion of your leave will end on [DATE].
Then, on [DATE], your leave will be designated as parental leave. Because you have requested [NUMBER
OF WEEKS] of parental leave, your parental leave will end on [DATE], and your return to work date will
be [DATE].
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: Designation Notice
© ThinkHR
[DATE]
[EMPLOYEE NAME]
[EMPLOYEE ADDRESS]
Regarding Recertification Request
Sent via [EMAIL ADDRESS, HAND DELIVERED, CERTIFIED USPS #]
Dear [EMPLOYEE NAME]
This is to inform you that we are requiring you to provide an updated medical certification of your
continued need for leave qualified under the Family and Medical Leave Act (FMLA) due to [STATE
REASON].
Enclosed is [CERTIFICATION FORM TITLE]. This form must be completed by your own physician or your
family member’s physician and should be returned to [NAME] via [ENTER METHOD] within 15 calendar
days from the date of this notice.
Unless and until the required recertification is provided, your absences will not continue to be
designated as protected leave under the FMLA. Without that designation, your absences may not be
protected or considered as approved.
If you have questions, contact me directly.
Sincerely,
[NAME]
[TITLE]
[CONTACT INFO]
Cc: [MANAGER NAME]
Encl.: [CERTIFICATION FORM TITLE]
