b. Personnel policy amended (FMLA)

PAGE 9 OF l~ • be required to reimburse us .for our share of health insurancN premiums paid. on yaur behalf during your E~MLP, leave. • I f we have riot i.nfarmed you above that you must use accrued paid leave while taking yaur unpaid F'MLA leave entitlement, you have the r°ight to have sick, vacation,and/ar other leave run car,cur~rerrtly with yaur unpaid leave entitlement, provided you meet any applicable requirements of the leave policy, Ak.7pliaabic ca:iditions related to the substitution of paid leave arH referenced ar set forth below. if you do not meet t:he requirements for taking paid leave, you remain entitled to take unpaid F?Mt1Ta, leave . Once we obtain the information from you as specified above, we will. inform you, within 5 business days, whether your leave will be designated as FMLA leave and count towards your FMLA l eave entitlement. If you have any questions, please contact your departmenC head (department head signature) PAPERWORI{ REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT It is m<~ndatot'y fa.r employers to provide employees with riot:ice of thc~:i r eligibility far FMLA px•otection and their righter arrd responsibilities: 2~ U.S.C. § 2617;23 C.F.R. § 825.300ib),(c) It is mandatary fpr employer:, to retain a copy of this disclosure in their records for three years. 23 U.5.C. § 2G16;~3 C'.F.R. § 825.500. Persons are not required to t4espand to this collection of information unless it displays a currently valid UMF3 control. number. 'I`he department of. Gabor estimates that it will. take an average of 10 minutes for respandent~ to complete this collection. of information, including the time for reviewing inskxuctons, searching e:cistiny data sources, gathering and maintaining the data needed, and completing and reviewing the collection of. information. 1f you have any commentF regaz~ding this burden estimate oz' any other aspect of this collection inf.o~.:mation, including suggestions f.or reducing this burden, send them to the Adminierr.rator. wage and Haur Division, t1. S. Depaztment of Labor, Raom 5-3502, 200 Constitution Ave., Nw, Washington, i3C 20210. DO NOT SEND THE COMPLST$D FORM TO THE WAGE AND HOUR DIVISION.