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NNPS public document collection | Retrieved 2026-10-26
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Eligible employees may also receive up to 26 weeks of unpaid, job-protected leave during a single 12-month
period to care for a covered servicemember with a serious injury or illness incurred in the line of duty.
Leave Forms & Supporting Documents
Access leave forms and medical certification documents below.
Employee Rights and Responsibilities under FMLA
Certification of Health Care Provider for Employee's Serious Health Condition
Certification of Health Care Provider for Family Member's Serious Health Condition
Certification of Qualifying Exigency For Military Family Leave
Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave
Leave of Absence Application
Leave of Absence Physician Statement
Not sure what forms you need?
Visit the Request Leave section below to get started.
Request Leave
Click the link below to complete the Leave Request Intake Form. The questionnaire will help identify your leave
needs and guide you to the appropriate forms and resources.
Request Leave
OR
Scan the QR code to access the form from your mobile device.
Submitting this form does not automatically approve leave. Employees must continue to follow normal call-out
and attendance procedures while your request is being reviewed. Supporting medical documentation is required
to support the leave request.
QR Code for Leave Request
Report Approved Intermittent FMLA Time
This form is only for employees who have an approved Intermittent FMLA certification on file with NNPS
Benefits.
Use this form to report time missed from work due to your approved Intermittent FMLA condition, including:
Full-day FMLA absences
Partial-day FMLA absences
Late arrivals
Early departures
Click the link below to access the Intermittent FMLA Reporting Form.
Report FMLA Time
OR
Scan the QR code to access the form from your mobile device.
Intermittent FMLA Absence Guidelines
Review the Intermittent FMLA Absence Guidelines for information regarding reporting absences, employee
responsibilities, and call-out procedures.
Intermittent FMLA Absence Guidelines
QR Code to Report FMLA TimeJump to an indexed page (3 of 3)