For serious health conditions and pregnancy/childbirth recovery:

• Certification of Health Care Provider for Employee’s Serious Health Condition
• Certification of Health Care Provider for Family Member’s Serious Health Condition
• Certification of Serious Illness or Injury of Current Servicemember
• Certification of Serious Illness or Injury of Veteran Servicemember

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:

• Certification of Qualifying Exigency for Military Family Leave

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.

Employee completes these forms:

• Employee's Statement of Claim
• Employee's Authorization for Release of Medical Information
• Options Statement

Doctor completes this form:

• Attending Physician's Statement

HR staff assigned to your agency complete this form:

• Employer's Statement of Claim

Information about submitting a claim and the State’s Short/Long Term Disability Plan are located at these two links: 

• Instructions for Submission of a Disability Claim
• Short- and Long-Term Disability Program Employee Handbook 

• Quick Steps for Submitting an FML Request
• Quick Steps for Attaching Documents to Request (e.g., Certifications of Health Care Provider)
• Quick Steps for Recording Use of FML in PS/Time & Labor
• View presentation on request process in PeopleSoft® FMLA module
• View presentation on recording process in PeopleSoft® Time & Labor Tutorial
• Tutorial for Employees

• Quick Steps for Delegating an Alternate User for functions during an absence
• Quick Steps for Managers regarding FML request
• Quick Steps for HRDs regarding FML request
• Quick Steps for Reporting Time on Behalf of an Employee
• Tutorial For Managers and HR Staff

• Sample Call-in Form
• Sample Record of Dates/Hours of FML Used
• Sample Record of Dates/Hours of FML Used - IDOC custody/12-hr shifts

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.

Leave may be taken for the following qualifying events:

1. Birth of a child.
2. Placement of a child for adoption or foster care.
3. For the care of a spouse, child or parent who has a serious health condition.
4. The serious health condition of the employee which prevents the employee from performing the essential functions of his/her job.
5. 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.  
6. For the care of a covered servicemember with a serious injury or illness.

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.

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.
• New Parent Leave, IF requested by FML eligible employee, will be charged concurrently.
• 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.

• Serious Health Condition  
• Qualifying Exigency
• Care for a Covered Servicemember
• FML Dictionary