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State of Connecticut Human Resources CORE CT Coding For Leave of Absence under the Federal Family and Medical Leave Act (FMLA) And/or State C.G.S. 5-248a (Family and medical leave from employment)
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How to fill out 5-248a family and medical
How to fill out 5-248a family and medical and who needs it:
01
Assess your eligibility: The 5-248a family and medical form is typically required for employees who need to take time off work for family or medical reasons. Determine if you qualify for this leave by reviewing your company's policies and local laws.
02
Obtain the form: You can usually obtain the 5-248a family and medical form from your human resources department or download it from your company's intranet or the relevant government website.
03
Read the instructions: Familiarize yourself with the instructions provided on the form. It will outline the details you need to provide and any supporting documentation required.
04
Fill in personal information: Start by filling in your personal information, such as your name, employee ID, job title, and contact information. Ensure accuracy and legibility.
05
Specify the leave reason: Indicate the reason for your leave, such as a serious health condition, the need to care for a family member, or certain qualifying events like pregnancy or adoption. Provide details as requested, including dates and anticipated duration.
06
Complete medical certification: If the leave is medical-related, you may need your healthcare provider to complete a section certifying your condition and need for leave. Make sure they provide the necessary medical information and sign the form.
07
Provide employer details: Fill in the information about your employer, including company name, address, and contact information. This section may also require a supervisor's signature or approval.
08
Attach supporting documentation: If required, attach any supporting documentation specified on the form, such as medical reports, birth certificates, or adoption paperwork. Ensure you make copies for your records before submitting.
09
Sign and date the form: Once you have completed all the necessary sections, sign and date the form to certify the information you provided is accurate to the best of your knowledge.
10
Submit the form: Submit the filled-out 5-248a family and medical form according to the instructions provided. Typically, you will need to submit it to your human resources department or directly to your supervisor.
Who needs 5-248a family and medical?
01
Employees requiring time off for their own serious health condition.
02
Employees needing to care for a family member with a serious health condition.
03
Individuals anticipating or undergoing pregnancy, childbirth, or adoption.
04
Employees requiring time off to bond with a newly adopted or fostered child.
05
Those seeking leave under state or federal family and medical leave laws.
06
Employees dealing with qualifying exigencies related to a family member's military service.
07
Individuals requiring time off for issues related to domestic violence, sexual assault, or stalking.
Note: The specifics of who needs to fill out this form may vary depending on local laws and company policies. It is essential to consult your relevant labor laws and employer guidelines for accurate information.
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