№ lp_1_2_38880
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Formal notification of an employee’s eligibility for FMLA and CFRA leave, detailing the conditions, responsibilities, and rights during such leave.
Note:
Year
Region / City:
California
Subject:
Family and Medical Leave
Document Type:
Employee Notice
Organization:
School District
Recipient:
Employee
Applicable Period:
12-month leave cycle
Related Legislation:
Family and Medical Leave Act (FMLA), California Family Rights Act (CFRA)
Rights and Obligations:
Eligibility for leave, health benefit continuation, job protection, periodic reporting, use of paid leave
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2018
Region / City:
United States
Topic:
Family and Medical Leave, Employee Rights, Military Leave
Document Type:
Legal Notice
Organization / Institution:
University
Author:
Not specified
Target Audience:
University Employees
Period of Validity:
January 1, 2018
Date of Approval:
January 1, 2018
Date of Changes:
Not specified
Context:
Legal notice outlining eligibility and responsibilities for Family and Medical Leave (FML) under FMLA and CFRA for eligible university employees.
Year:
[Date of Notice]
Region / City:
California, USA
Document Type:
Employee Leave Notification
Organization:
[Company Name]
Recipient:
[Employee Name]
Leave Type:
California Family Rights Act (CFRA) Leave
Leave Duration:
[Insert Start Date] to [Insert End Date]
Previously Used Leave:
[Insert # of Hrs, Days or Weeks]
Remaining Leave:
[Insert # of Hrs, Days or Weeks]
Return to Work Date:
[Insert Date]
Paid Time Off Available:
Sick: [Insert] Vacation: [Insert] PTO: [Insert] Other: [Insert]
PFL Application Status:
[Selected Option]
Health Benefits Continuation:
Up to [Insert # of weeks, up to 12 weeks]
Payment Responsibility:
Employee premium contribution $[Insert] per month
Included Notices:
Change in Relationship, Family Care and Medical Leave Fact Sheet, Paid Family Leave Brochure
Jurisdiction:
Oregon, United States
Subject:
Employee leave entitlements
Type of document:
Informational policy table
Programs referenced:
Family and Medical Leave Act (FMLA); Oregon Family Leave Act (OFLA); Paid Leave; Short Term Disability
Covered situations:
Serious health condition; Parental leave; Sick child leave; Pregnancy related disability; Military family leave; Bereavement leave; Qualifying exigency leave; Military caregiver leave
Benefit duration:
12 to 26 weeks depending on qualifying condition
Measurement period:
52-week period; single 12-month period (for Military Caregiver Leave)
Family members covered:
Spouse; Parent; Child; Sibling; Grandparent; Grandchild; Individuals related by blood or affinity
Definition references:
Oregon state law definitions of spouse and domestic partnership
Note:
Date
Contextual description:
This document is a formal notice related to the Family and Medical Leave Act (FMLA) designation, outlining the process for leave approval and requirements for employee documentation.
Year:
2018
Region / City:
United States
Topic:
Family and Medical Leave, Employee Rights, Military Leave
Document Type:
Legal Notice
Organization / Institution:
University
Author:
Not specified
Target Audience:
University Employees
Period of Validity:
January 1, 2018
Date of Approval:
January 1, 2018
Date of Changes:
Not specified
Context:
Legal notice outlining eligibility and responsibilities for Family and Medical Leave (FML) under FMLA and CFRA for eligible university employees.
Year:
Not specified
Region / Institution:
UNC Health Care System
Department:
Department of Anesthesiology / UNC Hospitals
Related Offices:
Reimbursement Office; CMS Medicare/Medicaid
Subject:
Time allocation and cost reporting
Document Type:
Internal Q&A guidance
Audience:
NPPs, CRNAs, Adjunct Faculty, clinical staff
Program Reference:
Time Trex time study
Regulatory Framework:
CMS Medicare/Medicaid cost reporting requirements
Scope:
Clinical services, resident training, academic instruction, grant-funded activities, hospital services, and administrative duties
Contact Information:
Reimbursement Office (966-5032)
Note:
Date
☐ Caregiver – Intermittent – Patient’s Name:
Relationship to you:
☐ Caregiver – Block of Time – Patient’s Name:
Relationship to you:
Year:
2026
Region / City:
Seattle, WA
Subject:
Employee Leave under FMLA
Document Type:
Official HR Form
Organization / Agency:
City of Seattle Human Resources
Author:
Human Resources Manager
Target Audience:
Employees requesting FMLA leave
Effective Period:
As specified upon employee notification
Approval Date:
Not explicitly stated
Revision Date:
Not explicitly stated
Required Information:
Employee details, leave reason, certification, supporting documentation
Leave Duration:
Up to 26 workweeks in a 12-month period for servicemember care; up to 520 hours (pro-rated) for other qualifying reasons
Insurance and Benefits:
Health benefits continuation requirements, optional insurance coverage, premium payment responsibilities
Return to Work:
Job reinstatement rights, notification requirements for early return
Type of Source:
HR administrative form
Official Guidelines:
Rights and responsibilities under FMLA, eligibility criteria, documentation requirements
Form Instructions:
Completion by HR manager or designee, checkboxes and date entries required
Year:
2026
Region / City:
United States
Topic:
Family and Medical Leave
Document Type:
Request Form
Organization / Institution:
Human Resources
Author:
Human Resources Department
Target Audience:
Employees requesting leave
Period of Action:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
1993
Jurisdiction:
United States
Topic:
Employment law, family and medical leave
Document type:
Federal law summary
Issuing body:
U.S. Department of Labor
Audience:
Employees and employers
Coverage period:
Continuous since 1993
Eligibility requirements:
12 months of employment and 1,250 hours worked in previous 12 months
Leave entitlement:
12 weeks per year
Health conditions covered:
Serious physical or mental illness, pregnancy, chronic disorders, substance abuse treatment
Family members included:
Child, spouse, parent
Health care provider definitions:
Physicians, nurse practitioners, psychologists, and other certified providers
Absence types:
Planned or unforeseen for qualifying reasons
Legal protections:
Job security, continuation of health benefits, prohibition of retaliation
Year:
20xx
Region / City:
United States
Subject:
Family and Medical Leave Act (FMLA)
Document Type:
Certification Form
Agency / Organization:
U.S. Department of Labor
Author:
U.S. Department of Labor
Target Audience:
Employees seeking military family leave under the FMLA
Period of Validity:
From the date of submission
Approval Date:
N/A
Modification Date:
N/A
Note:
Year
Region / City:
Carmel
Topic:
Urban Forestry
Document Type:
Official Program Outline
Organization / Institution:
City of Carmel
Author:
Urban Forestry Committee
Target Audience:
Residents of Carmel, City Officials, Environmental Organizations
Effective Period:
Ongoing
Year:
Not specified
Region / City:
United States
Theme:
Federal procurement, government contracts
Document type:
Informational guide
Organization / Institution:
General Services Administration (GSA)
Author:
Not specified
Target audience:
Potential FSS contractors
Period of validity:
Not specified
Approval date:
Not specified
Date of amendments:
Not specified
Year:
2023
Region / City:
Indianapolis
Topic:
Academic Faculty Policies
Document Type:
Faculty Guide
Institution:
Indiana University School of Medicine
Author:
Indiana University
Target Audience:
Faculty members at Indiana University School of Medicine
Period of Validity:
Ongoing
Approval Date:
2023
Date of Changes:
N/A
Note:
Audit ID
Text with blue background:
Fixed text – do not edit
Text entry area with Green background:
Entity-supplied information
Text entry area with white background:
Auditor-supplied information
Compliance Narrative (Required):
Provide a brief explanation, in your own words, of how you comply with this Requirement. References to supplied evidence, including links to the appropriate page, are recommended.
Evidence Requested:
Provide the following evidence, or other evidence to demonstrate compliance.
Registered Entity Evidence (Required):
The following information is requested for each document submitted as evidence. Also, evidence submitted should be highlighted and bookmarked, as appropriate, to identify the exact location where evidence of compliance may be found.
Note to Auditor:
Auditors are advised to monitor compliance with Requirement R1 during events, due to the importance of issuing Operating Instructions in such instances. Auditors can obtain a population of events for sampling from NERC’s, or the Regional Entity’s, records of mandatory event reports, other information available at the Regional Entities, or a query of the entity. Auditors are encouraged to monitor compliance during the most critical events on the entity’s system occurring during the compliance monitoring period.
Registered Entity Response (Required):
Question: Did the entity receive an Operating Instruction from the Reliability Coordinator during the audit period?
If No, state how this was ascertained. If yes, provide a list of instances of receiving Operating Instructions from the Reliability Coordinator. [Note:
A separate spreadsheet or other document may be used. If so, provide the document reference below.]
Type of document:
Policy and procedural guidance
Subject area:
Case management services
Jurisdiction:
Washington State
Governing laws and regulations:
RCW 74.34; RCW 74.39A.095
Program context:
Home and Community Services (HCS); Area Agency on Aging (AAA)
Covered settings:
In-home; residential; hospital; nursing facility
Primary roles described:
Case managers; social service specialists
Key topics:
Assessment; care planning; monitoring; mandatory reporting; service authorization; crisis intervention
Intended audience:
Case managers and social service staff
Revision information:
Revision history included
Source references:
Washington Administrative Codes (WACs); Revised Code of Washington (RCWs)
Contact role referenced:
Care Management Program Manager
Note:
Year
Document Type:
Policy
Target Audience:
Board Members, Management
Year:
2025
Region / City:
Colorado, Denver
Institution:
Metropolitan State University of Denver
Campus:
Auraria Campus
Topic:
Immigration enforcement on campus
Document type:
FAQ and guidance
Issuing body:
Immigrant Services Program
Related authorities:
Auraria Campus Police Department; U.S. Immigration and Customs Enforcement; Department of Homeland Security
Audience:
Staff, faculty, students
Legal framework:
FERPA; SEVIS
Period referenced:
2025 and beyond
Contacts provided:
Immigrant Services Program; University Legal Counsel; Colorado Rapid Response Network; International Student Coordinator
Year:
2023
Institution:
University of Wisconsin–Madison
Program:
ERP Graduate Program
Document Type:
Guidelines / Procedural Document
Audience:
Graduate students, Thesis committee members
Sections:
Student Responsibilities; Committee Member Responsibilities
Meetings Covered:
Certification, Prelim Preparation, Preliminary Exam, Subsequent Meetings, 6-Month Meeting, Thesis Defense
Forms Reference:
ERP Program Documents page (Current Students tab)
Mode of Meetings:
In-person or virtual
Submission Requirements:
ERP Certification Form, Thesis Committee Meeting Report Form, NIH-style biosketch
Timeline:
Minimum 2 months preparation for each committee meeting, specific deadlines prior to meetings specified