District of Columbia Designation of Family and Medical Leave Notice Form

Author: Katherine Hinde, Littler

When to Use

A covered District of Columbia employer may use this form to respond to employees' family and medical leave requests. The employer must inform the employee whether the request has been approved or denied under the federal Family and Medical Leave Act (FMLA) or the District of Columbia Family and Medical Leave Act (DC FMLA) and the reason for the denial, if applicable.

Employer coverage under these laws is as follows:

• The FMLA covers employers that employ 50 or more employees in 20 or more workweeks in the current or preceding calendar year and that are engaged in commerce or in any industry or activity affecting commerce.
• The DC FMLA covers employers that employ 20 or more employees in the District during 20 or more calendar workweeks in either the current or preceding calendar year.

Customizable Form