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J. J. Keller Support Center

Designation Notice Form Mapping

The information below walks through how the fields in the Designation Notice form are generated from Leave Manager.

Section I - Employer

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Letter Leave Manager Location Letter Leave Manager Location
A Current Date O

Leave Reason tab --> Select Leave Request Reason --> You are needed to

care for your family member who is a covered servicemember with a serious

injury or illness. You are the service member’s:

B

My Profile > Company Name P

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member who is a covered servicemember with a serious injury or

illness. You are the service member’s: Spouse

C Employee Q

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member who is a covered servicemember with a serious injury or

illness. You are the servicemember’s: Parent

D Leave Request Submitted Date R

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member who is a covered servicemember with a serious injury

or illness. You are the service member’s: Child

E

Leave Reason tab --> Select Leave Request Reason --> The birth of a child, or

placement of a child with you for adoption or foster care, and to bond with the

newborn or newly-placed child

S

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member who is a covered servicemember with a serious injury or

illness. You are the service member’s: Next of kin

F

Leave Reason tab --> Select Leave Request Reason --> Your own serious

health condition

T Leave Reason tab --> Select Leave Request Reason --> Other
G

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member due to a serious health condition.

Your family member is your:

U Leave Reason tab --> Select Leave Request Reason --> Other <Drop down item>
H

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member due to a serious health condition. Your family member

is your: Spouse

V Status Tab --> Approved/Open dropdown selection: = True
I

"Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member due to a serious health condition. Your family member is

your: Child under age 18 
OR 
Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member due to a serious health condition. Your family member

is your: Child 18 years or older and incapable  of self-care  because of a mental

or physical disability

W Status tab -->  Select the status for this request: Denied
J

Leave Reason tab --> Select Leave Request Reason --> You are needed to care

for your family member due to a serious health condition. Your family member

is your: Parent

X Status tab -->  Select the status for this request: Denied  & -->
The FMLA does not apply to the employee’s leave request.
K

A qualifying exigency arising out of the fact that your family member is on

covered active duty or has been notified of an impending call or order to covered

active duty status. Your family member on covered active duty is your:

Y

Status tab -->  Select the status for this request: Denied  &   --> As of the date the

leave is to start, the employee does not have any FMLA leave available to use.

L

Leave Reason tab --> Select Leave Request Reason --> A qualifying exigency

arising out of the fact that your family member is on covered active duty or has

been notified of an impending call or order to covered active duty status.

Your family member on covered active duty is your: Spouse

Z

Status Tab --> Select the status for this request: Denied  &  --> Other

Status Tab --> Select the status for this request: Denied  &  --> Other

(user text box specifying other)

M

Leave Reason tab --> Select Leave Request Reason --> A qualifying exigency

arising out of the fact that your family member is on covered active duty or has

been notified of an impending call or order to covered active duty status.

Your family member on covered active duty is your: Child

AA Status Tab --> Select the status for this request: Open
N

Leave Reason tab --> Select Leave Request Reason --> A qualifying exigency

arising out of the fact that your family member is on covered active duty or has

been notified of an impending call or order to covered active duty status.

Your family member on covered active duty is your: Parent

   

 

Section II - Additional Information Needed

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Letter Leave Manager Location Letter Leave Manager Location
BB

Administrative tab --> Administrative Information  --> Section D. Name of contact

person for employee questions:

FF

Status tab -->  Select the status for this request: Open  & --> 
Please specify the information needed to make the certification complete

and/or sufficient:

CC

Administrative tab --> Administrative Information  --> Section D. Please provide

a phone number or email address where this person can be reached:

GG Status tab -->  Select the status for this request: Open  & -->
Provided no later than [DATE] (allow at least 7 calendar days)
DD

Status tab --> Select the status for this request: Open -- > Certification is

Incomplete = true

HH

Status tab -->  Select the status for this request: Open  & -->
We request that the employee obtain a. _(second or third)_ medical certification

at our expense, and we will provide further details at a later time.

EE

Status tab --> Select the status for this request: Open -- > Certification is

Insufficient = true

II

Status tab -->  Select the status for this request: Open  & -->
We request that the employee obtain a. _second_ medical certification at our

expense, and we will provide further details at a later time. 
OR
Status tab -->  Select the status for this request: Open  & -->
We request that the employee obtain a. _third_ medical certification at our

expense, and we will provide further details at a later time.

 

Section III - FMLA Leave Approved

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Letter Leave Manager Location Letter Leave Manager Location
JJ

Status tab -->  Select the status for this request:
 Approved/Open
Provided there is no change from the anticipated FMLA leave schedule, the

number of hours, days, or weeks will be counted against the employee’s

leave entitlement.

PP

Administrative Tab --> Other: (e.g., short-or long-term disability, workers’

compensation, state medical leave law, etc.) (checkbox)

KK Calculation QQ

Administrative Tab --> Other: (e.g., short-or long-term disability, workers’

compensation, state medical leave law, etc.) (User's text)

LL

Status tab -->  Select the status for this request: Approved/Open
The leave will be unscheduled. It is not possible to provide the number of hours,

days, or weeks that will be counted against the employee’s leave entitlement at

this time. Thereby, the employee has the right to request this information once

in a 30-day period (if leave was taken within a 30-day period).

RR

Status tab -->  Select the status for this request:
 Approved/Open  & -->
The employee   __ will be   __ will not be. Required to provide a certification

from your health care provider (fitness-for-duty-certification) that the employee is

able to resume work.

C Employee SS

Status tab -->  Select the status for this request:
 Approved/Open  & -->
The employee  __will be   __ will not be. Required to provide a certification

from your health care provider (fitness-for-duty-certification) that the employee

is able to resume work.

MM

Administrative Tab --> Some or all of your FMLA leave will not be paid. Any

unpaid FMLA leave taken will be designated as FMLA leave and counted against

the amount of FMLA leave you have available to use in the applicable

12-month period. (checkbox)

TT

Status tab -->  Select the status for this request:
 Approved/Open  & -->
The employee is required to present a fitness-for-duty certificate to be restored

to employment.= will be & --> A list of essential functions IS attached, the

fitness-for-duty certification must address your ability to perform the essential

job function.

NN

Administrative Tab --> You have requested to use some or all of your available

paid leave (e.g., sick, vacation, PTO) during your FMLA leave. Any paid leave

taken for this reason will also be designated as FMLA leave and counted against

the amount of FMLA leave you have available to use in the applicable

12-month period. (checkbox)

UU

Status tab -->  Select the status for this request:
 Approved/Open  & -->
The employee is required to present a fitness-for-duty certificate to be restored to

employment.= will be & --> A list of essential functions IS NOT attached, the

fitness-for-duty certification must address your ability to perform the essential

job function.

OO

Administrative Tab --> We are requiring you to use some or all of your available

paid leave (e.g., sick, vacation, PTO) during your FMLA leave. Any paid leave

taken for this reason will also be designated as FMLA leave and counted against

the amount of FMLA leave you have available to use in the applicable

12-month period. (checkbox)

   

 

 

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