APWU FMLA Forms
Available for download-- for your convenience.
We've made available several different APWU-authored and officially sanctioned FMLA forms, as well as two forms for use by veterans for Verification of Treatment, and Clarification of Medical Certification.
Please take the time to read the FMLA FAQs developed jointly by the APWU and USPS. You will find many good examples of questions commonly asked-- and the answers can help guide you to filing the proper form.
*FMLA Form 1*
Employee Certification of Own Illness
This form is to be used by employee when requesting FMLA and
medical documentation is not required
pursuant to Sections 513.36 and 515.5 of the ELM.
*FMLA Form 2*
Certification by Employee's Health Care Provider for Serious Illness
This form is to be completed by employee's Health Care Provider
when employee is requesting FMLA and
medical documentation is required pursuant to
Sections 512.41, 513.36 and 515.5 of the ELM.
Form PS 3971 must be completed by the employee.
*FMLA Form 3*
Health Care Provider Certification of Employee's Family Member Illness
This form is to be completed by employee's Health Care Provider
when employee is requesting FMLA.
*FMLA Form 4*
Notice of Need for Intermittent Leave or For Reduced Work Schedule
Employee will need to attach APWU FMLA Medical Documentation Form 2
or Form 3 if for a family member's illness.
*FMLA Form 5*
Absences For Birth of Placement of a Child under FMLA
Absence due to care for a new son or daughter or the placement
of a son or daughter is not a serious medical condition
and does not require certification from a health care provider,
but it may require documentation.
*APWU Form 6*
USPS Verification of Veteran's Treatment
Verifies that the employee is being treated at a VA facility.
*APWU Form 7*
Management Request for Verification of Medical Certification
Verifies that the employee is being treated at a VA facility.
