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SPD > Policies & Procedures > Family & Medical Leave Family & Medical Leave

For Employees

For Managers & HR staff


The Family and Medical Leave Act of 1993, as amended in 2008, allows eligible employees of a covered employer to take job-protected, unpaid leave, or to substitute paid leave if earned or accrued.

Eligibility

To be eligible for family medical leave employees must have:

  • Been employed in an agency under the executive authority of the governor for at least 12 months (consecutive or non-consecutive).
  • Have worked at least 1,250 hours in the 12-month period immediately preceding the need for family-medical leave.
  • Have not exhausted their allotment of family-medical leave in the applicable time period.

Qualifying Events

Leave may be taken for the following qualifying events:

  1. Birth of a child.
  2. Placement of a child for adoption or foster care.
  3. For the care of a spouse, child or parent who has a serious health condition.
  4. The serious health condition of the employee which prevents the employee from performing the essential functions of his/her job.
  5. Because of a qualifying exigency arising out of the fact that the employee’s spouse, child or parent is on covered active duty or call to covered active duty status.  
  6. For the care of a covered servicemember with a serious injury or illness.

Learn more about these common FML events

Applying for Family Medical Leave

To apply for family medical leave, log-in to PeopleSoft® Self-Service.

An e-mail address is needed to complete the application process.
No e-mail account? There are several sites on the internet that provide e-mail accounts at no charge. Yahoo | Hotmail | Gmail

  • Review the CERTIFICATION FORMS below and choose the one that applies to your reason for needing FML. The Certification forms are not interchangeable.  
  • Download the correct certification form, fill-in the identifying information, and submit the form to the  Health Care Provider (HCP) for completion. 
  • Within the time limit (15 days for initial certification / 7 days for clarification) retrieve the certification from the HCP and upload it to your request (See Quick Steps for Attaching Documents to Request). If there are extenuating circumstances making it impossible for you to submit the certification or clarification within the time limit, then you must call the FML Line at 317.234.7955 or 1.855.773.4647 and request an extension.  Deadlines cannot be extended after they have expired – call before the 15- or 7-day limit has passed.
  • Check your email account frequently for information about your request.

Certification Forms

For serious health conditions:

For Birth or Placement of a Child:

For a Qualifying Exigency related to military deployment of your spouse, child, or parent:

Deadlines

If the need for leave is foreseeable, requests must be submitted at least 30 days prior to taking the leave, or if this is not possible, on the same or next business day of learning of the need for leave. Absent approval of a timely request for extension due to extenuating circumstances, documentation supporting the need for foreseeable leave must be submitted prior to the beginning of the leave, but no later than 15 calendar days after notice of the need for leave.

If the need for leave is not foreseeable, requests must be submitted in accordance with general leave request policies – 15 minutes before the shift or one hour before shift in a 24/7 operation - barring extenuating circumstances which prevent notice by the employee, or employee’s spokesperson, within that time frame. Absent approval of a timely request for extension due to extenuating circumstances, documentation supporting the need for unforeseeable leave must be submitted no later than 15 calendar days after the beginning of the leave.

Recording FML Usage

Leave taken for FML must be documented in your timesheet/attendance report.  If you submit your time through PeopleSoft® Time & Labor, use Quick Steps for Recording Use of FML in PS/Time & Labor.

Concurrent use of compensatory time earned, sick, vacation, or personal leaves, worker’s compensation or the state’s Short/Long Term Disability Plan should also be recorded for each day on the applicable timesheet/attendance report required by your agency.

Disability Forms

If there is a chance that a leave for the employee’s own serious health condition may last more than 30 calendar days, then the employee should apply for the state’s Short/Long Term Disability Plan by completing and submitting these forms to the address/fax listed on the forms as soon as the need for leave becomes known.

Employee completes these forms:

Doctor completes this form:

HR staff assigned to your agency complete this form:

Information about submitting a claim and the State’s Short/Long Term Disability Plan are located at these two links: 

Frequently Asked Questions 

State and Federal Policies on Family-Medical Leave

These documents explain how family-medical leave is administered by the State of Indiana for its state employees.  It does not apply to other employers.

US Department of Labor’s Notice to Employees of Rights under the FMLA
This document is required by the US DOL to be provided to employees of covered employers. The State of Indiana is a covered employer.

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