Hawaii Designation of Family and Medical Leave Notice Form

Author: Katherine Hinde, Littler

When to Use

A covered Hawaii 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) and the reason for the denial, if applicable. Though not required by state law, the employer should also inform the employee of the same for requests under the Hawaii Family Leave Law (HFLL) and Hawaii's pregnancy disability leave law.

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 HFLL covers employers that employ 100 or more employees for each working day during 20 or more calendar weeks in the current or preceding calendar year.
• The pregnancy disability leave law covers all employers in Hawaii.

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