Wisconsin 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 Wisconsin Family and Medical Leave Act (WFMLA). 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.
• The WFMLA covers employers that employ 50 or more individuals on a permanent basis, during at least six of the past 12 calendar months. The law does not indicate whether the 50 or more employees refers to employees in Wisconsin or all employees. The more conservative approach is to assume that the law refers to the number of employees overall.

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