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California Designation of Family and Medical Leave Notice

Author: Katherine Hinde, Littler

When to Use

A California employer may use this form to respond to employees' family and medical leave requests. The employer must inform the employee whether the request has been approved or denied under the federal Family and Medical Leave Act (FMLA), California Family Rights Act (CFRA) or California's Pregnancy Disability Leave (PDL) law; and the reason for the denial, if applicable. The form does not include non-medical leaves, including a qualifying exigency related to the covered active duty or call to covered active duty of an employee's spouse, domestic partner, child, or parent in the US Armed Forces.

Employer coverage under these laws are as follows:

  • The FMLA covers employers that employ 50 or more employees in 20 or more workweeks in the current or preceding calendar year that are engaged in commerce or in any industry or activity affecting commerce.
  • The CFRA covers employers that directly employ five or more employees.
  • California's pregnancy disability leave law covers employers that employ five or more full- or part-time employees for each working day in 20 consecutive calendar weeks in the current calendar year or preceding calendar year, regardless of whether the employee's worksite is located within or outside of California.

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