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FMLA Intermittent or Reduced Schedule Leave Time Request Form

Author: Steven J. Luckner, Ogletree Deakins

When to Use This Form

Employees must put their employers on notice that they wish to take intermittent or reduced schedule FMLA leave. Employers may require an employee to use the employer's customary and usual notice and other procedural requirements (such as a form like this) to request leave and the employee's failure to follow such procedures may be viewed as the employee's failure to provide the necessary notice of the need for FMLA leave.