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20 March 1996
USASC&FG Reg 690-21

APPENDIX A

FAMILY AND MEDICAL LEAVE

1. PURPOSE. The purpose of this appendix is to set forth the procedures and responsibilities concerning the Family and Medical Leave Act (FMLA). These instructions are published to inform employees, supervisors, and managers of regulatory and procedural requirements applicable to requesting and granting leave under the FMLA.

2. APPLICABILITY. This appendix applies to all appropriated fund and nonappropriated fund employees who are serviced by the Directorate of Human Resources and have completed at least 12 months of service (does not have to be consecutive or 12 recent months). In addition, Title I employees must have worked for at least 1250 hours during the 12 months immediately preceding the beginning of the leave. Service in a Title I position is not creditable for meeting the 12 months of service requirements for non Title I application.

3. RESPONSIBILITIES.

a. Commanders, directors, and personal staff.

(1) Act as the approving official for request for leave under the

(2) Determine the availability of alternative positions.

b. Director of Human Resources.

(1) Provides advice and assistance to management officials and employees concerning matters relating to FMLA policies, laws and regulations.

(2) Interprets and applies regulations and provisions of labor management agreement in this area.

(3) Determines creditable service for eligibility for FML.

(4) Determines what position is an equivalent position.

(5) Assists management in determining if an alternative position meets the criteria established by the OPM.

(6) When unpaid leave is used, maintains health benefits in the same manner as for other employees on LWOP.

c. Operating officials and supervisors.

(1) Orient all employees of the provisions and the requirements of this policy and the applicability of current labor-management agreement, ensuring that there is a mutual understanding between the employee and the appropriate supervisor concerning the proper use of this type of leave.

(2) Provide employee with guidance on his/her rights and obligations under FMLA.

d. Employee.

 

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(1) Submits requests for FMLA in accordance with the provisions of this regulation.

(2) Provides medical documentation as required to support requests due to serious illness of the employee and/or a family member.

4. LEAVE ENTITLEMENT.

a. An employee shall be entitled to a total of 12 administrative workweeks of unpaid leave during any 12-month period for one or more of the following reasons:

(1) The birth of a son or a daughter of the employee and the care of such son or daughter;

(2) The placement of a son or daughter with the employee for adoption or foster care;

(3) The care of a spouse, son, daughter, or parent of the employee, if such spouse, son, daughter, or parent has a serious health condition; or

(4) A serious health condition of the employee that makes the employee unable to perform the essential functions of his or her position.

b. An employee shall take only the amount of family and medical leave that is necessary to manage the circumstances that prompted the need for leave.

c. Except as provided in the case of the birth or adoption of a child, the 12-month period begins on the date an employee first takes leave for a family or medical need and continues for 12 months. An employee is not entitled to 12 additional workweeks of leave until the previous 12-month period ends and an event or situation occurs that entitles the employee to another period of family or medical leave. (This may include a continuation of a previous situation or circumstance.)

d. The entitlement to a total of 12 administrative workweeks of leave for the birth or adoption of a child:

(1) May begin prior to or on the actual date of birth or placement for adoption or foster care; and

(2) Shall expire 12 months after the date of birth or placement. Leave for a birth or placement must be concluded within 12 months after the date of birth or placement.

e. Family Medical Leave is available to full-time, intermittent, and part-time employees. A total of 12 administrative workweeks will be made available equally for a full-time or part-time employee in direct proportion to the number of hours in the employees regularly scheduled administrative workweek. The 12 administrative workweeks of leave will be calculated on an hourly basis and will equal 12 times the average number of hours in the employee's regularly scheduled administrative workweek. If the number of hours in an employee's workweek varies from week to week as it could for employees working on intermittent schedules, a weekly average of the hours scheduled over the 12 weeks prior to the date leave commences shall be used as the basis for this calculation.


 

 

20 March 1996

USASC&FG Reg 690-21

f. If the number of hours in an employee's regularly scheduled administrative workweek is changed during the 12-month period of family and medical leave, the employee's entitlement to any remaining family and medical leave will be recalculated based on the number of hours in the employees current regularly scheduled administrative workweek.

g. When an employee's request for FML is approved, he/she must be provided guidance concerning his/her rights and obligations.

h. Leave may not be subtracted from an employee's FML entitlement unless confirmation (a request) has been received from him/her of the intent to invoke entitlement to FML.

birth;

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i. A husband and wife who are eligible for FML leave and are employed by this installation are permitted to take only a combined total of 12 weeks of leave during any 12-month period if the leave is taken:

(1) For birth of a son or daughter or to care for the child after

(2) For placement of a son or daughter for adoption or foster care, or to care for the child after placement; or

(3) To care for a parent (but not a parent "in-law") with a serious health condition.

Where the husband and wife both use a portion of the total 12-week FMLA leave entitlement for one of the purposes above, the husband and wife would each be entitled to the difference between the amount he/she has taken individually and 12 weeks for FML leave for a purpose other than those above. For example, if each spouse took 6 weeks of leave for the birth of a child, each could later use an additional 6 weeks due to a personal illness or to care for a sick child.

j. Family Medical Leave(FML) may be taken all at once, or in parts as indicated below:

(1) Leave taken because of the birth or placement of a child for adoption or foster care will not be taken intermittently or on a reduced leave schedule unless it is specially requested by the employee and approved by the approving official.

(2) Leave taken to care for a sick family member or for an employees own serious health condition may be taken intermittently or on a reduced leave schedule when medically necessary.

(3) If an employee takes leave intermittently or on a reduced leave schedule that is foreseeable based on planned medical treatment or recovery from a serious health condition, the approving official may place the employee temporarily in an available alternative position for which the employee is qualified and that can better accommodate recurring periods of leave. Upon returning from leave, the employee shall be entitled to be returned to his or her permanent position or an equivalent position.

k. Generally, FML will be LWOP.

(1) An employee may elect to substitute the following paid time off for any or all of the periods of leave taken:

 

 

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USASC&FG Reg 690-21

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(a) Accrued or accumulated annual or sick leave consistent with current law and regulations governing the granting and use of annual or sick leave.

(b) Advanced annual or sick leave approved under the same terms and conditions that apply to any other employee who requests advanced annual or sick leave.

(c) Leave made available to an employee under the Voluntary Leave Transfer Program.

(d) Compensatory time off.

(2) An employee will not be denied the right to substitute paid time off for any or all of the periods of leave taken.

(3) An employee will not be required to substitute paid time off for any or all of the periods of leave taken.

(4) An employee will notify the approving official of his/her intent to substitute paid time off for any or all of the periods of leave to be taken.

5. REQUEST FOR FAMILY MEDICAL LEAVE.

a. A request (memorandum) to take FML will be submitted by the employee through his/her supervisor to the approving official. The request must be submitted 30 days before the leave is to begin or as soon as it is practicable and must specify:-,

(1) The purpose of the leave,

(2) The period of the leave, and

(3) If paid leave is to be used for part of the period, the request must state if paid leave is to be used at the beginning or end of the period.

b. Requests due to the serious illness of the employee or a family member must include medical documentation as indicated in paragraph 6, this appendix.

c. An SF 52 must be submitted to the CPAC for AF employees if unpaid leave will exceed 30 calendar days, and a DA Form 4017 (Request for Personnel Action - Nonappropriated Fund Instrumentality) for NAF employees if unpaid leave will exceed 5 workdays.

d. When a request for FML is approved, the employee must be provided guidance on his/her rights and obligations.

e. Distribution of approved request for AF employees is as follows:

(1) The original memorandum with medical certificate, if required, will be forwarded to the Technical Services Branch, CPAC.

(2) One copy will be forwarded to the Civilian Payroll Section, Defense Finance Accounting Service, DFAS-DAO-CL, Code PSR, 130 West Ave. Suite A, Pensacola, FL 32508.

(3) One copy will be returned through the employing organization to the requestor.

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20 March 1996

USASC&FG Reg 690-21

f. Distribution of approved request for NAF employees is as follows:

(1) The original memorandum with medical certificate, if required, and one copy will be forwarded to the NAF Branch, CPAC. The NAF Branch, CPAC, will forward the appropriate copies to the Central NAF Payroll Office, Texarkana, Texas.

 

(2) One copy will be returned through the employing organization to the requester.

 

g. In case of disapproval, the memorandum will be so documented with an explanation and returned to the employee concerned.

6. MEDICAL CERTIFICATION. A written medical certification provided by the health care provider is required when FML is due to a serious illness of the employee or a member of the employee's family.

a. This medical certification must include:

(1) Employee's name.

(2) Patient's name and relationship to the employee (if other than the employee).

(3) Diagnosis.

(4) Date the serious health condition commenced.

(5) Probable duration of condition.

(6) Regimen of treatment to be prescribed by the physician, practitioner, or another provider of health services, if referred by the physician or practitioner. (Indicate the number of visits, general nature and duration of treatment, including referral to other provider of health services. Include schedule of visits or treatment if it is medically necessary for the employee to be off work on an intermittent basis or to work less than the employee's normal schedule of hours per day or days per week.)

b. If leave is due to the serious illness of the employee, the certification must include answers to the following questions:

(1) Is inpatient hospitalization of the employee required?

(2) Is employee able to perform work of any kind?

(3) Is the employee able to perform the essential functions of his/her position? (Answer after reviewing the statement of essential functions when provided by the employee's supervisor or after discussion with the employee if no statement is provided.)

c. If leave is related to caring for the employees seriously ill family member, the certification must include answers to the following questions:

(1) Is inpatient hospitalization of the family member required?

(2) Does (or will) the patient require assistance for basic medical, hygiene, nutritional needs, safety, or transportation?

 

 

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20 March 1996

USASC&FG Reg 690-21

c. Except as otherwise provided by or under law, a restored employee shall not be entitled to-

(1) The accrual of any employment benefits during any period of leave; or

(2) Any right, benefit, or position of employment other than any right, benefit, or position to which the employee would have been entitled had the employee not taken the leave.

d. For the purpose of applying paragraph 7c, above, the same entitlement and limitations in law and regulations that apply to the position, pay, benefits, status, and other terms and conditions of employment of an employee in a LWOP status shall apply to any employee taking LWOP under FMLA, except where different entitlement and limitations are specifically provided in the act and this regulation.

e. An employee is not entitled to be returned to the same or equivalent position under paragraph 7a, above, if the employee would not otherwise have been employed in that position at the time the employee returns from leave.

f. An agency may not return an employee to an equivalent position where written notification has been provided that the equivalent position will be affected by a reduction in force if the employee's previous position is not affected by a reduction in force.

g. A returning employee who has taken FML due to his/her own serious illness and occupies a position that has specific medical standards, physical requirements or covered by a medical evaluation program will be required to obtain a written medical certification that he/she is able to perform the essential functions of his/her position. The supervisor must inform the employee of this requirement before leave commences and the organization must pay the expenses for obtaining the written medical certification.

h. The approving official may require the employee to report periodically (no more often than every 30 calendar days) on his/her status and intentions to return to work. In requiring such reports, the approving official will take into account all of the relevant facts and circumstances of the employee's situation.

8. HEALTH BENEFITS.

a. AF Employees.

(1) An employee enrolled in a health benefits plan under the FEHB Program who is placed in a LWOP status as a result of entitlement to FML may continue his or her health benefits enrollment while on LWOP and arrange to pay the appropriate employee contributions into the Employees' Health Benefits Fund.

(2) An employee who is granted LWOP which exceeds 365 days of continuous coverage of FEHB, must pay the employee contributions directly to the civilian pay office on a current basis. Payment must be mailed by Friday following after the pay period in which the employee is covered. If the civilian pay office does not receive the payment by the date due, the employee will be notified by certified mail, return receipt requested, that

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20 March 1996

ATZH-XXX (690a) 20 October 1995

MEMORANDUM FOR (Immediate Supervisor)

SUBJECT: Request for Advance Sick Leave

 

1. It is requested that I be granted an advance of 120 hours of sick covering the period 16 October 1995 through 3 November 1995.

2. Specific information in support of this request is as follows:

a. I am a career-conditional employee with 2 years of civilian service.

b. I have exhausted all sick (and annual) leave credits.

c. A medical certificate from my physician stating the nature of my illness and the anticipated duration of my incapacity for duty is enclosed.

3. I expect to return to duty at the expiration of the requested leave.

4. In case of separation prior to liquidation above advance leave, I understand pay due me will be applied toward this indebtedness to the Government to liquidate same. I understand further, that if indebtedness is not cleared by pay due me at the time of separation, setoff will be made against my retirement fund.

 

Encl

EMPLOYEE'S SIGNATURE

EMPLOYEE'S TYPED OR PRINTED NAME

EMPLOYEE'S SOCIAL SECURITY NUMBER

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