Massachusetts Designation of Family and Medical Leave Notice Form

Author: Katherine Hinde, Littler

When to Use

A covered Massachusetts 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 Massachusetts Parental Leave Act (MPLA).

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 MPLA covers employers with six or more employees.

Customizable Form