Notice of Eligibility Rights and Responsibilities

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

In general, to be eligible a covered employee must have worked for an employing office for at least 12 months and have worked at least 1,250 hours in the 12 months preceding the leave. While use of this form by employing offices is optional, a fully completed form provides employees with the information required by the FMLA regulations issued by the Office of Compliance (OOC) Board of Directors (the Board) at 825.300(b), which must be provided within five business days of the employee notifying the employing office of the need for FMLA leave. Part B provides employees with information regarding their rights and responsibilities for taking FMLA leave, as required by the Board’s FMLA regulations at 825.300(b), (c).