Family Medical Leave Act (FMLA) Leave of Absence

You may qualify for a FMLA leave of absence if you meet the two following criteria:

  • have been employed for 12 months and worked 1250 hours in the preceding 12 months and
  • are off work or anticipate an absence of 3 or more calendar days due to
    • your serious personal illness, injury or pregnancy, or that of a qualified family member or;
    • intermittent absences due to serious illness of self, spouse, parent, or child.

If you meet the above qualifications, below are the steps for applying for FMLA leave of absence:

  • Contact HR in 165 Administration Building. If you cannot meet in person, you may call 678.3573. HR will ask questions about your illness or reason for taking leave and provide the required paperwork.
  • Provide at least a 30-day advance notice when possible to your department of the need to take leave, or as soon as possible. An employee should discuss the absence from work so that the department can make arrangements for his/her work load; employee is not required to share medical information with the supervisor or department head.
  • Submit a Request for Medical Leave to HR. The completed and signed form can be returned in person, by mail to 165 Administration Bldg, or by fax to 678.1650.
  • Meet with HR to obtain your Notice of Eligibility and Rights & Responsibilities (NOERR) and Certification of Health Care Provider (CHCP) forms. The CHCP must be returned within 15 days.
  • The Designation Notice will be provided to the employee within 3 days of receipt of sufficient CHCP documentation. A copy of the Designation Notice will also be provided to the department.

Reporting FMLA Leave 

  • Timesheets and leave reports for regular employees will include a new line item for “FMLA Leave.”
  • This line item is ONLY to be used by employees who are officially recognized by Human Resources as being on an approved FMLA leave on or after April 1. If you are not in possession of a FMLA Designation Notice from Human Resources, do NOT use the FMLA Leave line item.
  • Those employees who ARE on approved FMLA leave should ONLY enter their hours used on this new FMLA Leave line item; do NOT enter entries on the Sick Leave or Annual Leave line items in these cases. (This will cause double-dipping.)
  • FMLA Leave has been automatically programmed to deduct appropriately from the employee’s sick and then annual leave balances.
  • Employees on Paid Parental Leave (PPL) should continue to report their hours on the Paid Parental Leave line item. PPL should NEVER be reported as FMLA Leave.
  • HR is implementing this process as part of an improved method of tracking FMLA eligibility and leave usage within the Banner system.
  • If you have any questions about the FMLA Leave line item on your timesheets/leave reports OR if you have FMLA questions in general, please e-mail hrbp@memphis.edu


Additional Information