Applying for Family Medical Leave
- From the Main Menu choose Human Resources > Self-Service > Leave Administration > FMLA Leave Request.
- Need help navigating in PeopleSoft to the request screen? View Quick Steps for Submitting an FML Request
- Need more help? Scroll down to the Helpful Tools section on this page.
An e-mail address is needed to complete the application process.
No e-mail account? There are several sites on the internet that provide e-mail accounts at no charge. Yahoo | Hotmail | Gmail
- Review the CERTIFICATION FORMS below and choose the one that applies to your reason for needing FML. The Certification forms are not interchangeable.
- Download the correct certification form, fill-in the identifying information, and submit the form to the Health Care Provider (HCP) for completion.
- Within the time limit (15 days for initial certification / 7 days for clarification) retrieve the certification from the HCP and upload it to your request (See Quick Steps for Attaching Documents to Request). If there are extenuating circumstances making it impossible for you to submit the certification or clarification within the time limit, then you must call the FML Line at 317.234.7955 or 1.855.773.4647 and request an extension. Deadlines cannot be extended after they have expired – call before the 15- or 7-day limit has passed.
- Check your email account frequently for information about your request.
View Forms and Additional Information
For serious health conditions and pregnancy/childbirth recovery:
For leave for parenting your newborn or adopting or providing foster care to a child(ren):
- Documentation about the facts and time frames of the birth of your biological child you wish to spend time getting to know or activities related to adopting or becoming a foster parent to a child(ren) and time spent helping your newly-adopted or newly-placed foster child(ren) with adjustments and transitions. This leave is available only during the first year after the birth, adoption, or placement of the child(ren). View Information for Expectant Parents
For a qualifying exigency related to military deployment of your spouse, child, or parent:
It is your responsibility to ensure the Certification of Health Care Provider forms are filled out completely by the appropriate person and include description/details of medical necessity for and the estimated frequency and duration of absences for which you are requesting leave. Timely submission of the Certification of Health Care Provider form is YOUR responsibility , not your health care provider's.
Second and third opinions may be required. The State has the right to confirm that the Certification is authentic and may contact a health care provider to do so.
If Certification is not complete or contains illegible, ambiguous, contradictory, or vague answers, you may be required to get the health care provider to clarify the document. There is a 7 day time limit for clarification, and your request cannot be approved without submission of a properly completed Certification. Close this section
If there is a chance that a leave for the employee's own serious health condition may last more than 30 consecutive calendar days, then the employee must apply for the state's Short/Long Term Disability Plan by completing and submitting these forms to the address/fax listed on the forms as soon as the need for leave becomes known. This is a separate process and must be completed in addition to the FML process in appropriate situations.
View more details about completing the FML process
Employee completes these forms:
Doctor completes this form:
HR staff assigned to your agency complete this form:
Information about submitting a claim and the State’s Short/Long Term Disability Plan are located at these two links:
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Learn more about these common FML events
Helpful tools related to the FML process
View quick step guides, presentations and tutorials for employees
View quick step guides and tutorials for Managers & HR staff
View available tools for tracking FML usage
Are you eligible for FML?
The Family and Medical Leave Act of 1993, as amended in 2008, allows eligible employees of a covered employer to take job-protected, unpaid leave, or to substitute paid leave if earned or accrued.
Learn more about eligibility
To be eligible for family medical leave employees must have:
- Been employed in an agency under the executive authority of the governor for at least 12 months (consecutive or non-consecutive).
- Have worked at least 1,250 hours in the 12-month period immediately preceding the need for family-medical leave.
- Have not exhausted their allotment of family-medical leave in the applicable time period.
Learn more about Qualifying Events
Leave may be taken for the following qualifying events:
- Birth of a child.
- Placement of a child for adoption or foster care.
- For the care of a spouse, child or parent who has a serious health condition.
- The serious health condition of the employee which prevents the employee from performing the essential functions of his/her job.
- Because of a qualifying exigency arising out of the fact that the employee’s spouse, child or parent is on covered active duty or call to covered active duty status.
- For the care of a covered servicemember with a serious injury or illness.
Deadlines and Consequences
If the need for leave is foreseeable, requests must be submitted at least 30 days prior to taking the leave, or if this is not possible, on the same or next business day of learning of the need for leave. Absent approval of a timely request for extension due to extenuating circumstances, documentation supporting the need for foreseeable leave must be submitted prior to the beginning of the leave, but no later than 15 calendar days after notice of the need for leave.
- Failure to submit request and documentation in advance of foreseeable leave may result in denial of that request and a delay in FML coverage which will result in unauthorized leave subject to disciplinary action unless the absence(s) would otherwise be covered by other approved leave.
- Absences that can be scheduled in advance must be scheduled in advance. You are responsible for scheduling treatments and appointments outside work hours whenever possible. If not possible, then you are responsible for scheduling treatments and appointments on days and at times that cause the least disruption to agency operations.
If the need for leave is not foreseeable, requests must be submitted in accordance with general leave request policies - 15 minutes before the shift or one hour before shift in a 24/7 operation - barring extenuating circumstances which prevent notice by the employee, or employee's spokesperson, within that time frame. Absent approval of a timely request for extension due to extenuating circumstances, documentation supporting the need for unforeseeable leave must be submitted no later than 15 calendar days after the beginning of the leave.
- Requests and documentation submitted more than 15 days after the start of an absence may result in denial of FML coverage for those previous absence(s) which will result in unauthorized leave subject to disciplinary action unless the absence(s) would otherwise be covered by other approved leave.
- Barring extenuating circumstances, if an absence is unforeseeable or taken in the form of intermittent leave, you must comply with agency leave/call-in procedures and time limits, 15 minutes before the shift or 1 hour before the shift in 24 hour operations, for each day of absence. Failure to meet these time limits may result in denial of FML for any/all days for which procedures are not followed and may result in disciplinary action.
The State has five business days after receiving all the relevant documentation to respond to your request - absences taken prior to receiving that response may be unauthorized and subject to disciplinary action unless the absence(s) would otherwise be covered by other approved leave. Close
Recording FML Usage
Leave taken for FML must be documented in your timesheet/attendance report. If you submit your time through PeopleSoft® Time & Labor, use Quick Steps for Recording Use of FML in PS/Time & Labor.
Concurrent use of compensatory time earned, sick, vacation, or personal leaves, worker's compensation or the state's Short/Long Term Disability Plan should also be recorded for each day on the applicable timesheet/attendance report required by your agency. General Information on the use of other leave during FML absences:
- Compensatory Time Off accrued by eligible employees must be used first for any approved FML absence(s).
- Sick Leave required when reason for FML is the serious health condition of employee or employee's spouse, child, or parent.
- Vacation Leave, IF accrued and requested by employee for an FML absence, will be charged concurrently.
- Personal Leave, IF accrued and requested by employee for an FML absence, will be charged concurrently.
- Special Sick Leave, IF requested by eligible employee for an FML absence, will be charged concurrently.
- FML will be charged concurrently with absences under State's Short/Long Term Disability Plan (S/LTD) (up to 12 week maximum in a fiscal year).
- FML will be charged concurrently with Worker's Compensation absences that also meet FML qualifying definitions.
Frequently Asked Questions
State and Federal Policies on Family-Medical Leave
These documents explain how family-medical leave is administered by the State of Indiana for its state employees. It does not apply to other employers.
US Department of Labor’s Notice to Employees of Rights under the FMLA
This document is required by the US DOL to be provided to employees of covered employers. The State of Indiana is a covered employer.
Training materials and opportunities