The Department of Administrative Services is responsible for all statewide policies and regulations.  General Letter 39 – STATE OF CONNECTICUT FAMILY AND MEDICAL LEAVE ENTITLEMENTS POLICY – REVISED in March 2018 is the current statewide policy and is available by clicking on this link:  Family and Medical Leave.

Required Forms:

• These forms are the Employee’s Responsibility to complete and submit:
  • FMLA - HR1 Employee Request for Leave
  • FMLA - HR3 Statement of Intent to Return to Work
  • P – 33A Medical Certification and Fitness for Duty; or
  • P – 33B Caregiver Medical Certification Form

Once the Office of Human Resources is aware of the need for leave, you will receive a completed FMLA- HR2a Notice of Eligibility, Rights and Responsibilities Form outlining your rights, under the various entitlements, and the accompanying responsibilities you may have, if you are designated to one of the protected leaves.