On-the-Job Injury Optical Examination or Treatment (Job-related) Off-the-Job Injury Undergoing Medical, Dental, or Exposed to a Contagious Optical Examination or Treatment Disease (Not job-related) Pregnancy, Prenatal Care, or Childbirth. This request is associated with a new condition.

Request for or Noti cation of Absence Date Submitted (MM/DD/YYYY) No. of Hours Requested PP Year

FMI_A Designation is PENDING E] FMLA Protected Not FMLA Protected PS Form 3971, July 2021 (Page of2) PSN 7530-02-000-9136 Reason I was incapacitated for duty during this absence; Warning: The furnishing of infomatlon on form may result in a fine of not more than $10,000 or imprisonment of rot more than 5 years, or both (1B U.S.C. 7001).

Revised PS Form 3971 is now available from the Material Distribution Center (MDC) in Topeka, KS. You can order the revised PS Form 3971 through the MDC eBuy2 catalog.

Reuest for or Notification of Absence Employee’s Name (Print last, first, MI.)

Download a blank fillable Ps Form 3971 - Request For Or Noti Cation Of Absence in PDF format just by clicking the "DOWNLOAD PDF" button. Open the file in any PDF-viewing software.

Supervisor: Additional Documentation Regarding Denial of Leave Protection Under FMLA Employee Not Eligible -- Less than 1250 Hours Worked. Employee Not Eligible -- Not Employed with USPS 1 Year. Employee Has Exhausted FMLA Entitlement in Current Leave Year. Absence Not for a Covered Condition. Absence Not for a Covered Family Member.

View, download and print fillable Usps 3971, 2001, Request For Or Notification Of Absence in PDF format online. Browse 4 Usps Form 3971 Templates collected for any of your needs.