Forms and resources for institution leave administrators can be accessed below.

Employee forms and resources can be accessed on the Employee Forms & Resources web page.

  • Notice of Eligibility and Rights & Responsibilities (UWS 81) pdf - This form must be provided to an employee within 5 business days of an employee’s request for a WFMLA and/or FMLA-protected leave; or within 5 business days of learning an employee is eligible for coverage by WFMLA and/or FMLA.
  • Designation Notice (UWS 86) pdf - This form must be provided to the employee who has requested a WFMLA and/or FMLA-protected leave to let the employee know if the leave is approved and/or if the employee needs to submit any additional information before the leave can be approved.
  • HIPPA Authorization pdf - Complete this form if you (the employer) needs to obtain medical information directly from the health care provider.

Updated: 06/19/2024