Designation Notice
(Family and Medical Leave Act, as made applicable by the Congressional Accountability Act)

Form D

Leave covered under the Family and Medical Leave Act (FMLA), as made applicable by the Congressional Accountability Act (CAA), must be designated as FMLA-protected and the employing office must inform the employee of the amount of leave that will be counted against the employee’s FMLA leave entitlement. In order to determine whether leave is covered under the FMLA, the employing office may request that the leave be supported by a certification. If the certification is incomplete or insufficient, the employing office must state in writing what additional information is necessary to make the certification complete and sufficient. While use of this form by employing offices is optional, a fully completed form provides an easy method of providing employees with the written information required by the regulations issued by the Office of Congressional Workplace Rights (OCWR) Board of Directors at 825.300(d), 825.301, and 825.305(c).