FMLA for NYPD civilian employees
New York City has its own FMLA forms rather than the federal ones, and one of them is completed by your provider rather than by you. Here's the sequence, what each form is for, and where a provider fits in.
Start My Intake- $49 flat. Provider sections completed and signed by a state-licensed provider
- Usually within 24 hours after we have everything needed
- Kept private and never sent to your agency without your say-so
Which forms does NYC actually use?
Not the federal ones. If you've been reading about WH-380-E, that's the U.S. Department of Labor's version, and the City has its own.
You file DP-2494, the request for leave. Your provider completes DP-2496, the Certification of Physician or Other Health Care Provider. If your leave is for a new child rather than an illness, you sign DP-2495 yourself and attach proof of the birth or placement — no provider certification needed.
One thing worth knowing: the DP-2496 the City publishes is marked revision 6/97. It's shorter than the federal form and asks slightly different questions. Your agency may hand you the federal form anyway. Either way, the provider's part is the same job.
Which form is which
Tap a form to see what it's for.
Who fills out the medical certification?
Your provider does, and it isn't just a signature.
DP-2496 asks whether your condition fits one of six categories the FMLA recognizes as serious, and for the medical facts supporting that. It asks when the condition began and how long it's likely to last. It asks whether you'll need to work intermittently or on a reduced schedule, and how often.
Then it asks whether you're unable to do work of any kind, or whether you can work but can't perform specific essential functions of your job.
What does Certicare do here?
We complete the provider's part.
A state-licensed provider evaluates you, and if the evaluation supports it, completes the certification your agency needs: DP-2496, the federal WH-380 series, or whatever your agency handed you. Usually within 24 hours after we have everything needed.
What we can't do is get your leave approved. That's your agency's decision, and it's made on the whole request, not just the certification. What we control is that the provider's part is complete, specific, and signed by someone licensed to certify it. If you need a note for a short absence instead, that's covered on the NYPD civilian page.
$49 covers your full case: clinical review, the supported forms it needs, and any verification, clarification, or corrections — no additional charges.
Secure online intake. Your information is reviewed by Certicare and is not sent to your agency without your authorization.
A provider evaluates you and completes documentation when it's medically appropriate. Payment isn't a purchase of a completed form: a provider may follow up with questions, or decide the evaluation doesn't support what's being asked. Your agency decides whether to approve your leave. If we can't complete your documentation, you get a full refund.
Certicare is not affiliated with or endorsed by the New York City Police Department, the City of New York, or any union. Your agency makes the final decision on sick leave, medical leave, and accommodation requests. This page is general information, not legal advice.
Am I eligible for FMLA as a City employee?
Probably, if you've been with the City a while. The test is twelve months of City service and 1,250 hours actually worked in the past twelve months. Hours worked is the measure, not hours scheduled or paid, so paid leave doesn't count toward it.
FMLA gives you up to 12 weeks of leave in a 12-month period, and your job and health coverage are protected while you're out. It covers your own serious health condition, and caring for a spouse, child, or parent with one.
Sworn officers are eligible too. FMLA is federal law and it applies to uniformed members the same way.
How long do I have to return it?
Fifteen calendar days from when your agency asks for it, where that's practicable.
If what you send back is incomplete, your agency has to tell you in writing what's missing and give you at least seven more days to fix it. That's federal rule, not agency discretion.
What is MELD, and when does it get involved?
The Military and Extended Leave Desk. It handles Department leaves running more than 30 consecutive days, including FMLA, and it covers both civilian and uniformed members.
If your leave runs longer than 30 consecutive days, that's who you'll be dealing with.
What if I'm a sworn officer?
FMLA applies to you the same as anyone else, and this is one of the places where documentation from an outside provider genuinely is used.
That's different from a sick-leave note. A note from us can't place you on sick report, because your sick status runs through the Medical Division and your district surgeon. An FMLA certification is a different document doing a different job, and a provider outside the Department can complete it.
Founded by a licensed nurse practitioner
Rebecca Martel, APRN, FNP-BC, is the founder of Certicare and a family nurse practitioner who has completed hundreds of these forms.