New PS Form 3971

New PS Form 3971
Revision has new look and expanded recording capability

A revised PS Form 3971, Request for or Notification of Absence — with a new look and functionality — is now available.

The revised form provides more space for requests and designation of protected leave under the Family and Medical Leave Act (FMLA).

The front of the form contains an expanded Remarks section and provides more specific instructions regarding FMLA designation.

The back of the 3971 includes assistance to help employees determine whether the request is a potential FMLA-protected absence. There’s also a space to enter an FMLA case number to make sure the requested leave is associated with a previously approved or designation-pending FMLA case.

The form is available on Blue. It also can be ordered from the Topeka Fulfillment Center through USPS eBuy2 system under the MDC eBuy2 catalog. The National Stock Number (NSN) is 7530-02-000-9136.

The form also can be ordered using Touch Tone Order Entry (TTOE) at 800-273-1509 by those who have a 10-digit-access code or call 800-332-0317 to register for TTOE.

Current forms, dated March 2008 or earlier, should be destroyed.

Download New 3971 (PDF)
Form courtesy of Don Cheney – Auburn WA

3 Responses to "New PS Form 3971"

  1. Randy Zelznick   September 1, 2012 at 8:07 pm

    Here’s a fillable and saveable PDF of the new form you can make available on your site:

    http://www.21cpw.com/Dec2011-PSForm3971.pdf

    Thanks Randy
    Rick Owens – PEN

  2. Jo   October 6, 2015 at 1:04 pm

    Where on this form can I ask for a permanent change of schedule?

  3. gman   October 9, 2017 at 1:46 pm

    the fillable form doesn’t work

    Sorry gman – I just filled it out…works for me. Rick – PEN

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