An FMLA leave request letter must be specific enough to trigger your employer’s obligations under the Family and Medical Leave Act. Under 29 CFR §825.302, you must provide enough information for your employer to determine that the leave qualifies under FMLA — but you do not need to use the phrase “FMLA” explicitly.
Key Takeaways
- FMLA provides up to 12 weeks of unpaid, job-protected leave per year for a serious health condition, family care, or birth/adoption.
- You must have worked at least 12 months and 1,250 hours at a company with 50+ employees within 75 miles.
- Provide at least 30 days’ notice for foreseeable leave (planned surgery, birth). For emergencies, notify as soon as practicable.
- Once you request leave for an FMLA-qualifying reason, your employer has 5 business days to respond with an eligibility notice.
- Your employer can require medical certification within 15 calendar days of your request.
- Intermittent FMLA leave is available for medical treatments that can be scheduled around work.
- Using the phrase “I need time off for a serious health condition” is sufficient — you do not need to say “FMLA.”
Template Letter: FMLA Leave Request
[Your Name]
[Your Address]
[Date]
[Manager's Name]
[Company Name]
[Company Address]
Subject: Leave Request Under the Family and Medical Leave Act
Dear [Manager's Name],
I am writing to request leave under the Family and Medical Leave Act (FMLA).
**Reason for leave:**
I require leave due to [my own serious health condition / the serious health condition of a family member / the birth or adoption of a child / military family leave — select one].
**Expected leave dates:**
I expect my leave to begin on [Start Date] and continue for approximately [X] weeks. I anticipate returning to work on [Return Date].
If my leave is for intermittent treatment, I expect to need time off on [specific days or schedule — e.g., "every Tuesday for 8 weeks for medical treatment"].
**Medical certification:**
I understand that [Company Name] may require medical certification within 15 calendar days. I am happy to provide the necessary documentation from my healthcare provider.
**Coverage:**
I have discussed my workload with [Name], who will cover [specific responsibilities] during my absence.
Please let me know if you need any additional information or forms to process this request.
Thank you for your assistance.
Sincerely,
[Your Full Name]FMLA Notice Timeline
| Notice Type | When to Provide | Employer Deadline |
|---|---|---|
| Initial request | At least 30 days for foreseeable leave. As soon as possible for emergencies. | — |
| Employer eligibility notice | — | Within 5 business days of request |
| Rights and responsibilities notice | — | Within 5 business days of request |
| Designation notice | — | Within 5 business days of receiving enough information |
| Medical certification | Within 15 calendar days of employer’s request | Employee must provide within 15 days |
| Certification response | — | Employer must review and respond within 5 business days |
FMLA Eligibility Criteria
| Criteria | Requirement |
|---|---|
| Employer size | Private employer with 50+ employees within 75 miles of your worksite |
| Public employers | All public agencies and schools are covered regardless of size |
| Length of service | 12 months (need not be consecutive) |
| Hours worked | At least 1,250 hours in the 12 months before leave |
| Leave reason | Birth/adoption, serious health condition (self or family), military family leave, qualifying exigency |
FMLA Leave Entitlement
| Situation | Maximum Leave |
|---|---|
| Own serious health condition | 12 weeks per 12-month period |
| Family member’s serious health condition | 12 weeks per 12-month period |
| Birth or adoption | 12 weeks per 12-month period |
| Military caregiver leave | 26 weeks per single injury/illness |
| Qualifying exigency (military family) | 12 weeks per 12-month period |
Medical Certification
Your employer can require medical certification for FMLA leave. The certification form (WH-380) must be completed by your healthcare provider. You have 15 calendar days from your employer’s request to provide it.
If you fail to return the certification within 15 days, your employer can delay FMLA leave until you do.
States with Paid Family and Medical Leave
Some states have their own paid family and medical leave programs that complement FMLA:
| State | Paid Leave Provided | Substitutes for FMLA? |
|---|---|---|
| California | Up to 8 weeks PFL | Runs alongside FMLA (unpaid job protection + state-paid benefits) |
| New York | Up to 12 weeks PFL | Runs alongside FMLA |
| Washington | Up to 12 weeks PFML | Runs alongside FMLA |
| Massachusetts | Up to 20 weeks PFML | Runs alongside FMLA |
| Oregon | Up to 12 weeks PFML | Runs alongside FMLA |
| Colorado | Up to 12 weeks FAMLI | Runs alongside FMLA |
| Connecticut | Up to 12 weeks PFML | Runs alongside FMLA |
Frequently Asked Questions
Do I need to mention FMLA in my request?
No. The Department of Labor regulations state that an employee does not need to use the term “FMLA.” Saying “I need time off for a serious health condition” is sufficient to trigger your employer’s obligations.
What if my company has fewer than 50 employees?
You are not covered by FMLA. Check your state’s laws — some states have their own family and medical leave laws with smaller employer thresholds (e.g., California, Oregon, Washington, Massachusetts).
Can my employer deny my FMLA request?
Your employer can deny FMLA leave if you do not meet the eligibility criteria, if you fail to provide timely medical certification, or if the reason does not qualify under FMLA. Your employer must provide a written reason for denial.
What if I need intermittent FMLA leave?
Intermittent leave is available when medically necessary — for example, chemotherapy treatments every two weeks. Your medical certification must support intermittent leave. You must make a reasonable effort to schedule treatments around your work schedule.
Does FMLA require my employer to pay me?
No. FMLA leave is unpaid. Some states provide paid family and medical leave benefits. Some employers offer paid sick leave or PTO that you can use during FMLA leave. Check your employer’s policy.
Related Reading
- Jury Duty Leave Letter: Employee and Employer Templates
- Military Leave Letter: USERRA Notice Templates
- Sick Leave Email to Your Boss: 10 Copy-Paste Examples
- Bereavement Leave Email and Letter Templates
- Can Your Employer Deny PTO?
Simplify FMLA Leave Administration
Leave Balance tracks FMLA usage against the 12-week entitlement, sends employers eligibility check reminders, and keeps a complete record of every FMLA request — so nothing falls through the cracks.