Family and Medical Leave Act (FMLA) Toolkit
In compliance with the federal Family and Medical Leave Act (FMLA), The University of New Mexico provides eligible employees up to twelve (12) weeks of job-protected leave within a twelve (12) month period, for eligible family and medical reasons and/or up to twenty-six (26) weeks for Military Family Leave.
FMLA is subject to the conditions outlined in Section 4.5 of Administrative Policies and Procedures Manual - Policy 3440: Family and Medical Leave.
Department Documents
- FMLA Tracking Log
Use this spreadsheet to track an employee’s usage of their available FMLA hours.
Employee Documents
- FMLA Request Form for Employees (En Español)
Who Should complete this document? The Employee.
Absence Management Documents
- FMLA Notice of Eligibility, Rights, and Responsibilities (Employer Response) (En Español)
Who Should complete this document? The Employer, and then given to the Employee after leave has been requested, but prior to the Designation Notice. - FMLA Designation Notice (En Español)
Who Should complete this document? The Employer, and then given to the Employee, after the Employer has provided the Employee with the Notice of Eligibility, Rights, and Responsibilities. - Recertification Letter - Certified/Regular Mail
Who Should complete this document? The Employer, and then sent to the Employee, if the Employee's original FMLA Certification has lapsed OR the Employee's use of FMLA Leave has increased. - Recertification Letter - Hand Delivery
Who Should complete this document? The Employer, and then given to the Employee, if the Employee's original FMLA Certification has lapsed OR the Employee's use of FMLA Leave has increased. - FMLA Eligibility Calculator
Use this tool to determine if you are eligible for FMLA. Supervisors may also use the calculator to determine an employee’s eligibility.
Health Care Provider Certification Documents
- Certification of Health Care Provider for Employee's Serious Health Condition (FMLA)-WH-380-E
Who Should complete this document? The Employee, Employer, and Health Care Provider.
- Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA)-WH-380-F
Who Should complete this document? The Employee, Employer, and Health Care Provider.
- Certification for Serious Injury or Illness of Covered Service member for Military Family Leave (FMLA)-Form WH-385
Who Should complete this document? The Employee, Employer, and Health Care Provider.
- Certification of Qualifying Exigency for Military Family Leave (FMLA) Form WH-384
Who Should complete this document? The Employee and the Employer.
- FMLA Certification for Serious Injury or Illness of a Veteran for Wage and Hour Division Military Caregiver Leave -- Form WH-385V
Who Should complete this document? The Employee, Employer, and Health Care Provider.