Thank you for completing your FMLA request in self service.
Attached are a few forms that will need to be filled out to request FMLA. The FMLA form needs to be filled out by you and a physician (form return instructions are on the form for the doctor). The Return To Work form is to keep for when your FMLA ends. The third document is a list of commonly asked questions to help guide you through the FMLA process.
The Department of Labor requires the medical certification is completed and returned to Mosaic within 15 days of the date you received the document.
Once the forms are completed, they can be submitted to the service center via email to [email protected] or via fax to 402-894-4781.
Here is a link explaining the Colorado FAMLI leave program: https://myfamliplus.state.co.us
Please read this information closely. FAMLI is designed to run concurrently with FMLA. You will be required to use PTO until your claim for paid leave benefits has been approved.