Pennsylvania Code & Bulletin

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 3392 (June 24, 2023).

55 Pa. Code § 3041.77. Verification of maternity and family leave.

§ 3041.77. Verification of maternity and family leave.

 Acceptable verification of family leave includes one of the following:

   (1)  A birth certificate.

   (2)  The Department’s medical assessment form.

   (3)  A written statement or other documentation completed by a licensed physician that describes the inability to work or participate in education or training and includes a date of anticipated return to work.

   (4)  A written statement from the employer or an education or training representative.

   (5)  A collateral contact, as specified in §  3041.62 (relating to collateral contact).

   (6)  A written self-declaration by the parent or caretaker, as specified in §  3041.64 (relating to self-declaration).

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