Request For Or Notification Of Absence Postalmagcom

Request for or notification of absence postalmagcom

File Name: form3971.pdf

File Size: 105.13 KB

File Type: Application/pdf

Last Modified: 6 years

Status: Available

Last checked: 1 days ago!

This Document Has Been Certified by a Professional

100% customizable

Language: English

We recommend downloading this file onto your computer


Request for or Notification of Absence
Employee's Name (Last, First, M.I.) Social Security No. Date Submitted No. of Hours Requested PP Year
Installation (For PM leave, show city, state, and ZIP code) N/S Day Pay Loc. # D/A Code From Date Hour Day Init. Hours
Time of Call or Request Scheduled Reporting Time Employee Can Be Reached At (if needed) Thru Date Hour
No Call 02
Type of Absence Documentation (For official use only) Revised Schedule for (Date) Approved in Advance Mon
Annual For FMLA Leave (Certification reviewed) Yes No
Carrier 701 Rule For COP Leave (CA 1 on file) 04
Begin Work Wed
LWOP (See reverse) For Advanced Sick Leave (1221 on file)
Sick (See reverse) For Military Leave (Orders reviewed) Lunch-Out
Late For Court Leave (Summons reviewed) 06
COP For Higher Level (I 723 on Me) Fri
Other: Scheme Training Testing, Qualifying (Memo on file) End Work Sat
Remarks (Do not enter medical information)
Total Hours Sun
I understand that the annual leave authorized in excess of amount available to me during the leave year will be changed to LWOP

Employee's Signature and Date Signature of Person Recording Absence and Date Signature of Supervisor and Date Notified
Official Action on Application (Return copy of signed request to employee) Wed
Signature of Supervisor and Date 12
Approved, not FMLA* Approved, FMLA Approved FMLA, Pending
(See Publication 71) Documentation Noted on Reverse. Thur
Disapproved (Give reason): 13
Ineligible for FMLA (Estimate eligibility date): Continued on Reverse 14
PS Form 3971, April 2001 (Page I of 2) Warning. The furnishing of false information on this form may result in a fine of not more
than $1 0,000 or imprisonment of not more than 5 years, or both. (18 U.S.C. 1001)
During This Absence, I Was Incapacitated for Duty by. Leave Types (Information Only) PP Year
Sickness Undergoing Medical, Dental, or Time Card PSDS
Leave Type
Optical Examination or Treatment Code Code
On-the-Job Injury - - Day Init. Hours
(Job related) AL-FMLA 55/01 32
Off-the-Job injury Sat
SL-FMLA 56/02 33
Undergoing Medical, Dental, or 01
Pregnancy and Confinement Optical Examination or Treatment LWOP - FMLA - Part Day 59/05 36
(Not job related) LWOP - FMLA - Full Day 60/06 37
Exposed to a Contagious Disease 02
- of Sick Leave 59/60 20
During This Absence, I Was Unavailable for Duty Because-, LWOP -Proffered 59/60 21
LWOP Personal Reasons 59/60 22
Sick Leave for Dependent Care Placement of a Child with Employee Tue
LWOP -Part Day 59 23
for Adoption or Foster Care 04
Birth of Child - Bonding LWOP -Full Day 60 23
Additional Information Regarding Denial of Leave Protection Under FMLA: LWOP -AWOL 59/60 24
- (Not FMLA) - OWCP 49 25
Employee Not Eligible - Less than 1250 Hours Worked. Thur
LWOP -Maternity 59/60 26
Employee Not Eligible -- Not Employed with USPS 1 Year LWOP Suspension
- 59/60 27
LWOP Union Official 84 28
Employee Has Exhausted FMLA Entitlement in Current Leave Year. 07
LWOP Suspension
- Pending
Absence Not for a Covered Condition. Sat
Termination 59/60 29
Absence Not for a Covered Family Member. Continuation of Pay- USPS 71 03
- USPS-FMLA 71/03 Sun
Continuation of Pay 34
Requested Documentation Not Provided, 09
Continuation of Pay FMLA-IOD-OWCP 49/04 35
Documentation Provided. Does Not Meet Criteria for FMLA Protection. Mon
Court Duty 61 04
Additional Documentation Required Military Leave 67 05 I
89. Tue
Postmaster's Organization 08
Blood Donor Leave 69 09
Other Paid Leave 86 10
Convention Leave 66 12
Acts of God 78 13
Privacy Act: The collection of this information is authorized by 39 USC 401. 1001, 1003. 1005; 5 Veteran's Funeral 86 10
JSC 8339; and Public Law 103-3. This information will be used to grant or deny your request for Relocation 80 15
official leave from Postal Service duty. It may be disclosed under the routine uses given in Privacy Civil Defense 77 16
Act system notices USPS 050.020 and USPS 120.070 (see appendix of Administrative Support Civil Disorder 81 17
Manual or, if you wish to obtain a copy of these notices contact your personnel office). Completion Voting Leave 85 18
of this form is voluntary. If this information is not provided. Official leave may not be granted

PS Form 3971, April 2001 (Page 2 of 2)

Manual or, if you wish to obtain a copy of these notices contact your personnel office). Completion of this form is voluntary. If this information is not provided. Official leave may not be granted. …

Download Now

Documemt Updated

Popular Download

Frequently Asked Questions

How to write a formal leave of absence letter?

When requesting a formal leave of absence, your letter should include: 1 Request for a leave of absence, 2 The dates you expect to be away from work, 3 The date you plan to return to work, 4 An offer to provide assistance, if feasible, 5 Thanks for considering your request. More ...

When to request leave of absence outside of normal pto?

The most common reasons to request a leave of absence outside of normal PTO include: New child. Maternity and paternity leave are the most common reasons why employees take extended leaves of absence. Different companies might have different policies, but the FMLA covers the bare minimum requirements for coverage (more on that below).

How do i order the revised ps form 3971?

You can order the revised PS Form 3971 through the MDC eBuy+ catalog. Note: Some military sites without eBuy+ access can place orders by contacting their Joint Military Postal Activity (JMPA). * Price is current as of this date but is subject to change. The July 2021 edition of PS Form 3971 is now available on the Postal Service PolicyNet website:

How do you inform a coworker of an absence?

After sending your letter, decide with your supervisor how you will inform your colleagues of your absence. You may need to tell them personally, or someone may take care of it for you. Be sure to give adequate notice to any coworkers who work directly with you or otherwise depend upon your work.