Eligible employees who apply for an unpaid FMLA leave for any of the approved reasons must complete and submit to the Superintendent Form 3430.01 F1 ("Request for Unpaid FMLA Leave").

Eligible employees who apply for an unpaid FMLA leave for reason C ("to care for an immediate family member") or D ("the employee’s own serious health condition") must submit or cause to have submitted Form 3430.01 F2 ("Medical Certification from Health Care Provider"), and execute and provide to his/her health care provider Form 3430.01 F5 ("Health Care Provider Authorization for Release of Information") or a similar HIPAA-compliant release form.

Finally, employees who take leave for reason D ("the employee’s own serious health condition"), prior to returning to work, must submit to the Superintendent
Form 3430.01 F4 ("Fitness for Duty Certification"). Again, the employee will need to have executed and provided to his/her Health Care Provider Form 3430.01 F5 ("Health Care Provider Authorization for Release of Information") or a similar
HIPAA-compliant form.