Vermont 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 Vermont Parental and Family Leave Act (VPFLA). Under the FMLA, the employer must notify the employee whether they are eligible for FMLA 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 an FMLA 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.
• Under the VPFLA, employers with 10 or more employees who work an average of at least 30 hours per week must provide parental leave, and employers with 15 or more employees who work an average of at least 30 hours per week must provide both parental and family leave. The VPFLA does not indicate whether the number of employees refers to employees in Vermont or all employees. The more conservative approach is to assume that the law refers to the number of employees overall. 

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