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Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (Family and Medical Leave Act) RFID: ___ ___ OMB Control Number: 12350003 DO NOT SEND COMPLETED FORM TO THE DEPARTMENT

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How to fill out military caregiver leave request

01

Obtain the appropriate military caregiver leave request form from your employer.

02

Fill out your personal information, including your name, employee ID, and contact information.

03

Provide details about the military member you will be caring for, including their name, relationship to you, and branch of service.

04

Specify the dates and times you will need to take leave to provide care for the military member.

05

Attach any supporting documentation, such as medical certifications or military orders, if required.

06

Submit the completed form to your employer according to their policies and procedures.

Who needs military caregiver leave request?

01

Employees who are eligible to take military caregiver leave under the Family and Medical Leave Act (FMLA) may need to request this type of leave.

02

This could include individuals who are caring for a covered service member with a serious injury or illness incurred in the line of duty.

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What is military caregiver leave request?

Military caregiver leave request is a type of leave provided to employees to care for a covered service member with a serious injury or illness.

Who is required to file military caregiver leave request?

Employees who are eligible for FMLA leave and need to care for a covered service member with a serious injury or illness are required to file a military caregiver leave request.

How to fill out military caregiver leave request?

To fill out a military caregiver leave request, employees must provide information about the covered service member, the relationship to the service member, and the reason for the leave.

What is the purpose of military caregiver leave request?

The purpose of military caregiver leave request is to allow employees to take time off work to care for a covered service member with a serious injury or illness.

What information must be reported on military caregiver leave request?

Information such as the name of the covered service member, the relationship to the service member, the date when the serious injury or illness began, and the amount of leave needed must be reported on military caregiver leave request.

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