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Form 16874 Rev. 10/06 CERTIFICATION OF HEALTH CARE PROVIDER (Family and Medical Leave Act of 1993) TO BE COMPLETED BY THE EMPLOYEE: Employment Category: Non Ops (Not a train service employee) Train
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How to fill out FMLA certification - UTU:

01
Begin by reading the instructions provided with the FMLA certification form. These instructions will guide you on how to properly fill out the form and provide the necessary information.
02
Fill out your personal details, such as your name, contact information, and employee identification number, in the designated sections of the form.
03
Provide information about your employer, including the name of the company, address, and contact details of your supervisor or HR department.
04
Clearly state the reason for your FMLA leave and the specific dates you will need to be absent from work. Include any additional information or documentation required to support your request, such as medical reports or doctor's notes.
05
If your FMLA leave is related to a serious health condition, provide relevant details about your medical condition, the treatment you are undergoing, and the healthcare provider who is managing your care.
06
If your FMLA leave is for the care of a family member, indicate their relationship to you, their medical condition, the treatment they are receiving, and the healthcare provider overseeing their care.
07
Sign and date the certification form, ensuring that you have completed all the necessary sections and attached any required supporting documentation.
08
Submit the FMLA certification form to the appropriate department or individual within your organization as instructed.

Who needs FMLA certification - UTU:

01
Employees who are covered by the Family and Medical Leave Act (FMLA) and meet the eligibility requirements may need to obtain FMLA certification.
02
Individuals who require time off from work due to their own serious health condition or the care of a family member with a serious health condition may need FMLA certification.
03
The FMLA certification is necessary for employees to be eligible for protected leave under the FMLA and to ensure they receive job protection and continuity of health benefits during their approved leave period.
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FMLA certification - UTU is a form that employees can submit to request leave under the Family and Medical Leave Act specifically for members of the United Transportation Union.
Employees who are members of the United Transportation Union and wish to take leave under the Family and Medical Leave Act are required to file FMLA certification - UTU.
To fill out FMLA certification - UTU, employees need to provide personal information, details of the medical condition necessitating leave, and any supporting documentation required by the employer.
The purpose of FMLA certification - UTU is to inform employers of the need for leave under the Family and Medical Leave Act specifically for members of the United Transportation Union.
FMLA certification - UTU requires information such as the employee's name, date of the requested leave, reason for the leave, and any relevant medical documentation.
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