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FMLA Designation Notice

This letter is intended to respond to an employee's request for California Family Rights Act (CFRA) leave after taking family and medical/pregnancy disability leave.

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This letter contains all of the information that must be communicated to an employee regarding your company’s approval of CFRA leave, including:
  • Proper documentation of the amount of time taken
  • What benefits an employee may be eligible for
  • Whether the employee is responsible for paying the company for health insurance costs during the leave
  • The availability of paid time off either through accrued time at your company or through the state Paid Family Leave program.
  • Easy-to-use, fill-in-the-blank format
  • Downloadable, RTF file for you to personalize 
  • Sample form
This form is free for CalChamber members. Login and access the form now at HRCalifornia.com. Not a member? Find out more about the many benefits of membership.

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