Recipients are Leave Bank members who are affected by a personal or family medical emergency and are projected to exhaust all paid leave.
- Be a Leave Bank member for the current leave year.
- Experience a qualifying personal or family medical emergency and provide medical documentation.
- Receive approval from the Leave Bank Board.
- Use all accrued sick and annual leave before any Leave Bank leave can be applied.
- Be projected to exhaust all saved leave and be in a leave-without-pay status for at least 24 hours.
Yearly Hourly Cap
A recipient may only receive up to a yearly hourly cap.
- 480 hours for personal medical emergencies
- 480 hours for family medical emergencies
- 720 total hours of leave received within the membership period
Voluntary Leave Transfer Program (VLTP)
If you are participating in VLTP, you are also eligible to apply to be a Leave Bank recipient. Any approved Leave Bank hours will be applied to the timecard before VLTP hours can be used. VLTP hours received will be included when determining leave need under the Leave Bank and are considered available paid leave. For more information on the programs, check out leave sharing comparisons.
- Determine eligibility
- Determine if you need medical documentation
- Complete the following forms:
- Fax Cover Sheet (NIH 2941)
- Application (NIH 2940)
- Authorization to Disclose Information (NIH 2923)
- Confidential Medical Documentation Request
- Recipient Application Checklist - Use this checklist to help guide you through completing the application forms. It is for personal use only and does not need to be submitted with the above forms.
Submit application no later than 30 calendar days following the termination of your medical emergency via fax at 301-480-2579 or email to firstname.lastname@example.org. We suggest submitting your application 3-4 weeks prior to the start of your medical emergency, if possible. Please note, the Leave Bank Office will begin accepting recipient application for the 2021 membership year (applications that begin on or after 1/3/21) following the end of open enrollment on December 15, 2020.
Please note the Leave Bank Office will begin accepting recipient application for the 2021 membership year (applications that begin on or after 1/3/21) following the end of open enrollment on December 15, 2020.
Email email@example.com or call (301) 443-8393.