District of Columbia Family and Medical Leave Notice of Eligibility and Rights and Responsibilities Form

Author: Katherine Hinde, Littler

When to Use

This form may be used to inform employees of their eligibility for, and rights and responsibilities under, the Family and Medical Leave Act (FMLA) and the District of Columbia Family and Medical Leave Act (DC FMLA). Under the FMLA and DC FMLA, the employer must notify the employee whether they are eligible for leave within five business days of the employee's request. Each time an employer must provide the eligibility notice to an employee, it must also provide a rights and responsibilities notice.

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. 

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