Designation Notice – FMLA/OFLA ‐ GCBDA/GDBDA‐AR(6) 2‐2 Please be advised (check if applicable): You have requested to use paid leave during your FMLA and/or OFLA leave. An employer may also use this form to inform the employee that the certification is incomplete or … 29 C.F.R. In addition, the written notice will provide the employee with information regarding their rights and responsibilities under FMLA or OFLA. Designation Notice indicating if the employee’s leave is designated or not as OFLA bereavement leave. If leave is due to the employee’s own serious health condition, or to care for a covered family member with a serious health condition, to care for a Certification of Qualifying Exigency for Military Family Leave (Form WH-384). Any paid leave taken for this reason will count against your FMLA and/or OFLA leave entitlement. Aside from inserting this language into BOLI’s new form, employers subject to OFLA should have, at a minimum, “Notice of Eligibility” and “Designation Notice” forms that modify the DOL’s template forms as necessary to ensure compliance with OFLA. Designation Notice (Form WH-382). Designation Notice, form WH-382 – informs the employee whether the FMLA leave request is approved; also informs the employee of the amount of leave that is designated and counted against the employee’s FMLA entitlement. If approved, the Notice provides the Leave Request # for entering the leave on the employee’s timesheet (3) Once OFLA bereavement leave is approved and the Designation Notice is sent, any It is the employees’ responsibility to ensure a complete and sufficient medical certification is returned … the FMLA and OFLA leave laws, you may be required to provide a medical certification from a qualified health care provider within 15 calendar days of the receipt of your notice for eligibility to take protected leave. As covered employers should know, failure to timely provide either the required notice of rights and responsibilities (DOL Form WH-381) within five business days or the required designation notice (DOL Form WH-382) also within five business days may constitute interference with an employee's rights … § 825.300. A: Washington County will provide an employee with a written notice informing them of the leave designation and that their leave will be charged to their FMLA or OFLA leave bank. Act) WH-381 form and the Designation Notice (Family and Medical Leave Act) WH-382 form, and give to the employee via hand delivery or certified mail. Also attached is a form titled Designation Notice which contains other information for you regarding federal and state family medical leave rights, including an estimate of time that will count toward your protected time. OFLA Leave: Notice by Employee; Designation by Employer; Notice by Employer Regarding Eligibility or Qualification (1) Except in situations described in sections (2) and (3) of this rule, a covered employer may require an eligible employee to give 30 days written notice of the need for foreseeable leave, including an explanation of … OFLA: Intermittent Leave and Alternate Duty 839‑009‑0250 OFLA: Notice by Employee; Designation by Employer; Notice by Employer Regarding Eligibility or Qualification 839‑009‑0260 OFLA: Medical Verification and Scheduling of Treatment 839‑009‑0265 OFLA: Medical Verification in Languages Other than English … Notice of Eligibility and Rights & Responsibilities (Form WH-381). ... Enclosure (FMLA and/or OFLA Designation Notice form) CR4/13/17│RS. OFLA: Notice by Employee; Designation by Employer; Notice by Employer Regarding Eligibility or Qualification (1) Except in situations described in sections (2) and (3) of this rule, a covered employer may require an eligible employee to give 30 days’ written notice of the need for foreseeable leave, including an explanation of … FMLA OFLA Q&A FMLA OFLA Scenarios ... Agency Designation and Exhaust Eligibility Notification Eligibility Notification and Designation Exhaust Notice.