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9611 Form: What You Should Know

Each employee must submit the applicable form(s) at the same time, in complete and signed form. What to Include in the Application for Leave Under the FMLA The application form for leave under any of the FMLA must be in the following form: Form 9611— Application for Leave Under the Family and Medical Leave Act Form 9611. Get a fillable 9611 form template online. Fill and sign the form, print, and keep the original and your  print copy of the Form 9611 at your workplace. What to Do on the Application for Leave Under the FMLA leaves a worker with no entitlement to compensation during leave for certain reasons, such as an illness of the employee,  or the death of a family member or a close personal friend. The employee may request leave for up to 26 weeks and  only if he/she can provide credible information about the illness or death and/or that taking leave will adversely affect the employee's health. An employer may grant an employee leave to care for a family member who is sick or dying, but only if the employee can establish that the illness resulted from the employee's duty or responsibility to the family member. The FMLA generally does not provide leave for maternity leave, adoption leave, or other leave by adoption,  or on behalf of a sick or injured employee of a business with fewer than 50 employees, or leave to  relocate. The FMLA provides an employee with the option of taking leave in accordance with the FMLA or a State leave law,  if the leave is to meet the employee's personal medical needs. It does not provide employer  paid leave for the spouse or dependents of an employee when he or she is absent from the employer's workplace (except under  disability laws) for the spouse's/dependent's serious illness, or when it is reasonable to expect the employee will be absent from the  workforce for illness of dependents. A worker may claim FMLA leaves for the family members of a recently deceased employee  but not for family members who were not present. In order to be eligible for FMLA leave, an employee must comply with all applicable laws and regulations, including: An employee is not entitled to FMLA leave for a reason related to a Federal law or regulation.

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