UMCSN FMLA Leave Bank Audit Survey

UMCSN FMLA Leave Bank Audit Survey2024-11-05T14:42:18-05:00

1. Employee Name:

2. Employee ID:

3. Department/Unit:

4. Do you currently have an open FMLA claim?

Yes

5. If yes, please provide the approval date of your current claim:

6. What is the approved through date for your FMLA leave?

7. How much time do you have remaining in your FMLA leave bank?

Please specify the exact number of weeks and hours (e.g., 4.5 weeks or 3 weeks, 12 hours):

8. Please provide any comments or additional information regarding your FMLA leave status (if applicable):

9. I confirm that the information provided is accurate to the best of my knowledge.

Yes

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