Families First Coronavirus Response Act (FFCRA) Leaves

Family Medical Leave Act (Childcare) – For employees who are unable to work or telework.

Leave Request Form

Leave Request Form online 

Emergency Paid Sick Leave – For employees who are unable to work or telework.

Emergency Paid Sick Leave

Emergency Paid Sick Leave online 

Family Medical Leave Act (FMLA)/California Family Rights Act (CFRA)

The Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA) are laws that provide eligible employees up to 12 weeks of job protected unpaid leave in a 12-month period for:

  • Care of oneself or one’s family member with a serious health condition
  • Disability due to pregnancy, child birth, or related medical condition
  • Bonding/caring for a new born baby, or adopted or foster child
  • Military Family Leave

Eligibility – To be eligible for FMLA/CFRA you must have worked for the County for at least 12 months, and worked at least 1,250 hours during the 12 months immediately preceding the start of the leave of absence. If you are not eligible for FMLA/CFRA and you are pregnant, you are likely still eligible for Pregnancy Disability Leave.

To Request Leave – Fill out forms and send to Marin County Human Resources BENEFITS division, FAX to (415) 473-5960, or scan and send email.

Request for Family Medical Leave Form

During your leave – While you are on leave, you are encouraged to stay in touch with your supervisor or manager, particularly if there are any foreseeable changes to your return to work date.

Returning to work – Before returning to work from medical leave, you will be required to provide a Fitness for Duty to Return from Leave certification form or other medical release from your healthcare provider. You may also be eligible for modified duty or reasonable accommodation if you are returning to work with limitations. Modified duty is a temporary modification to the work assignment to help you transition back to regular duty. Reasonable accommodation is an adjustment to the work environment or to the manner the job is customarily performed to enable a disabled individual to perform essential job functions. Your return to work certification should include any and all limitations, if any.

Family and Medical Leave Process

Open All Panels

  • 1. Requesting Leave

    When absence is foreseeable, provide your supervisor with 30 days’ notice before taking a medical leave of absence under FMLA/CFRA. Foreseeable leaves of absence include pre-scheduled surgery and time off for child birth, and/or to bond with a new child. Complete the Request for Family and Medical Leave form. Should you need a leave of absence suddenly to care for yourself or a family member, you must notify your supervisor or HR as soon as practicable.

    Request for Leave Form

  • 2. Medical Certification

    FMLA/CFRA medical form must certify that absence is required for a ‘serious health condition’. It must include the start date of the condition, the expected duration of absence, the anticipated return to work date, and it must be signed by the health care provider. The certification must not include diagnosis, but must detail the required time away from work. The medical certification is private and confidential and should be submitted directly to Human Resources Department, within 15 days of your request for leave.

    Intermittent leave may be taken as the condition requires. However, the treating practitioner must provide specific information regarding frequency and duration of intermittent leave. If leave is for medical appointments, specific dates and times must be provided by the healthcare practitioner.

  • 3. Notification

    You will receive from Human Resources a notice of approval, provisional approval, or denial via US mail within a few days after you have sent your request. The letter will include contact information for you to call or email with any questions or concerns about your leave of absence.

  • 4. How You Are Paid While on Leave

    While FMLA, CFRA and PDL provide job-protected family/medical leave, the protected time off is unpaid. Therefore you must use your own sick leave accruals, and if eligible, integrate supplemental income such as State Disability Insurance (SDI), Paid Family Leave (PFL) and/or Long Term Disability (LTD) insurance to help pay for your time off.

    Notes on SDI and LTD Eligibility

    • SDI — Many employees pay into State Disability, which is generally determined by bargaining unit. If you are uncertain whether you pay into SDI, inquire with your HR Benefits representative.
    • LTD — Long Term Disability is an optional benefit that may be elected at the start of employment with the County or during open enrollment. This benefit is only available to those who select it and pay into it accordingly.
  • 5. Benefits — Possible Changes

    During the time you are on FMLA/CFRA, the County paid portion of health benefits (fringe) will continue. If you run out of accrued paid time off, you will be on a leave without pay, during which the County will continue to provide its customary portion of your benefits (fringe) and you will assume responsibility for the balance of your premium payments not covered by County fringe. You must work with the Department of Finance to pay directly for the balance due for your out-of-pocket premiums.

    Unpaid Leave of Absence After Protected FMLA/CFRA

    There are times when employees must remain on unpaid medical leave beyond protected FMLA/CFRA. In this case, in order to maintain your benefits coverage, you must pay the full premium contributions for yourself and any enrolled dependents. Payments are made directly to the Department of Finance. It is your responsibility to work with the Human Resources Benefits Department and Department of Finance to pay for the premiums or to make temporary changes to your plans. Failure to make timely premium payments for your benefits can result in the termination of your health benefits, which may not be reinstated until you return to work or during Open Enrollment.

  • 6. Your Responsibilities While on Leave
    • The most important part of your responsibilities while on leave is to remain in communication with your department, particularly if there is a foreseeable change to your return date whether you plan to return sooner or later than first expected.
    • If there is an extension to your return date send in the medical certification before your return date arrives, preferably a week or two before so that your department can plan for coverage of your usual duties.
    • If you are covered by State Disability, send in SDI payment statements to the payroll person in your department so that SDI payments are properly integrated with your paycheck. See Employee Rights and Responsibilities under FMLA.
  • 7. Returning to Work

    You will be required to provide a Fitness for Duty to Return from Leave Certification Form or other release to return note from your medical provider before returning to work. You may also be eligible for modified duty or accommodations if you are returning to work with limitations. Modified duty is a temporary modification to the work assignment to help you transition back to regular duty. A reasonable accommodation is an adjustment to the work environment or to the manner the job is customarily performed to enable disabled individuals to perform essential job functions.

Understanding the Difference Between Job Protection and How You are Paid

There are two aspects of leave that are important to understand: job protection and non-work income replacement. How you are paid depends on your own leave balances (sick, vacation, etc.), as well as your eligibility for income replacement through:

  • Worker's Compensation (WC), if the injury occurred on the Job
  • California’s State Disability Insurance (SDI), if illness or injury is not job related
  • Paid Family Leave (PFL), for illness or injury of family member
  • Long Term Disability (LTD), this optional insurance coverage

Workers’ Compensation (Temporary Disability) – Temporary Disability Workers’ Compensation payments are made when an injury or illness is accepted as work related. Temporary Disability payments are made direct to the employee by Tristar the County’s Third Party Administrator. Payments are approximately 2/3 of an employee’s average weekly wage up to the State maximum and may last up to two years.

State Disability (SDI) - SDI provides affordable, short-term (up to one year) benefit to eligible workers who suffer a loss of wages when unable to work due to a non-work-related illness or injury, or due to pregnancy or childbirth. SDI does not pay for the first 7 calendar days of the disability. If SDI approves your claim, you will receive up to 55% of your weekly salary for a maximum of 52 weeks. Benefits may be generated within 15 to 21 days after submitting the SDI claim, assuming all the necessary information is provided.

Paid Family Leave (PFL) – PFL was established for workers who suffer a loss of wages when they need to take time off from work to care for a seriously ill child, spouse, parent, registered domestic partner, or to bond with a new child. It pays up to six weeks of benefits.

The SDI and PFL programs are funded through payroll deductions. Note: Most but not all, County employees are covered. Check your union’s MOU or call an HR Benefits representative to find out if you are eligible to file a claim for SDI.

Tutorials on How to Register and File a Claim

Other Questions? Ask EDD.

Long Term Disability (LTD) - This insurance is an optional plan that you may choose at the time of hire and pays benefits only if you are unable to work for 90 days or more. LTD pays up to a maximum percentage of pre-disability income up to $3,000 per month. Benefits may be reduced by other payments you receive, such as SDI.

Employee Responsibilities While Receiving Workers Comp, SDI, PFL or LTD - It is not lawful to receive disability benefits AND a full paycheck. The total compensation received by you (paycheck + disability) cannot exceed 100% of standard base salary. Therefore, you must work with your department Payroll Person and the Department of Finance, to properly integrate disability benefits with your County paycheck. This is called integration.

Integration of Disability Benefits

Integration is a method of combining your paid time off (accruals) with disability benefits during a medical leave of absence. State Disability Insurance (SDI), Paid Family Leave (PFL), and Temporary Disability under Worker's (TD) all provide partial wage replacement during a medical leave of absence. It is not lawful to receive disability benefits and a full paycheck. Your total compensation (paycheck + disability) cannot exceed 100% of your standard base salary.

Employee Responsibilities

As soon as you receive a notice of benefits from SDI, PFL, or TTD (debit card, statement or check), you must coordinate with your department payroll technician(s) to provide a copy for the purpose of payroll integration. Typically you will receive a new statement biweekly or monthly, so this will be a recurring responsibility during your leave of absence. *

*If your individual medical circumstances prohibit you from carrying out these responsibilities, please call your HR Benefits Representative without hesitation to make alternative arrangements.