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Forms, Letters & Notices

The following templates are provided for agency use. They may be customized to include agency-specific details, such as contact information for your HR office. However, agencies should NOT make changes to the wording of the documents themselves. Any questions regarding customization of templates should be directed to OA-HR Service Center, Absence Services at 717.346.4667.
Please note that forms must often accompany specific letters.

Additional Sick Family

Only a permanent employee with at least 1 year of credited service is eligible to use additional accrued sick absence quota for the purpose of caring for the illness/injury of their qualifying family member. The employee must use 20 days (150/160 hours) of absence for the family member’s illness/injury before requesting to use additional sick absence quota for this purpose. A period of 20 days must be met for each separate family member and/or health condition within each leave calendar year.

  • Request for Additional Sick Family Absence: Completed by the employee, signed by the approving authority and approved by the human resource office. The allowance may only be granted after the employee has already exhausted their sick family entitlement for the current leave calendar year. The additional sick family absence must be used prospectively and may not be retroactively applied to any of the initial qualifying hours.

Leave Donation

The Leave Donation Program is designed for employees to donate accrued (actual) annual and personal absence quota to individuals who are approved to receive leave donations for a catastrophic injury or illness. Management and non-represented employees and employees covered under a bargaining unit that has entered into a side letter agreement with the commonwealth may qualify to receive leave donations if the injury or illness can be defined as severe. 

Military Leave of Absence

Additional information is located in the Employee Resource CenterMD530.26 Military Leaves of Absence, and in the Uniformed Services Employment and Reemployment Rights Act.

Miscellaneous Absence Forms