MCPS Form 440-35 is the physician certification Montgomery County Public Schools employees submit when requesting illness-related leave of five or more days. You complete the employee section, your health care provider documents the condition and expected absence, and the finished form goes to the Employee and Retiree Service Center (ERSC) at ersc@mcpsmd.org.1Montgomery County Public Schools. Employee Leave Information
The form is the medical piece of a two-part process. You still have to file MCPS Form 430-1, the leave application itself, through your principal or supervisor; Form 440-35 travels separately to the ERSC to keep your medical details out of the school-level paperwork chain.1Montgomery County Public Schools. Employee Leave Information
One boundary worth noting up front: Form 440-35 is only for employee leave. Documentation for a student’s extended absence or home and hospital teaching uses Form 311-15b through that program’s office.
Download and Print Before Your Appointment
Get the current PDF from the MCPS forms page at ww2.montgomeryschoolsmd.org/departments/forms/pdf/440-35.pdf.2Montgomery County Public Schools. MCPS Form 440-35 Certification of Physician Print it and bring it to the appointment. If your provider fills it out during the visit, you avoid a second trip or a round of phone calls over missing fields.
A provider’s statement on office letterhead is acceptable too, as long as it covers the same information the form requires.3U.S. Department of Labor. FMLA: Forms The district’s own form is still the cleaner option because the field prompts stop providers from leaving out details the ERSC will ask about later.
Filling Out the Form
The form has four parts. You handle Part I. Your physician completes either Part II or Part III depending on who the patient is. The physician signs Part IV.
Part I: Your Information
Enter your name, your relationship to the patient (yourself or the family member), and the patient’s name if different from yours. Include your MCPS employee ID number so the ERSC can match the certification to your leave request without hunting for it.
Part II: Your Own Health Condition
Your physician completes this section when the leave is for you. The form asks for:
- The date the condition started, meaning when symptoms began or when it was diagnosed.
- Beginning and estimated end dates of your absence. If no end date is possible, the provider should say so and give the date of your next appointment instead.2Montgomery County Public Schools. MCPS Form 440-35 Certification of Physician
- Diagnosis and treatment plan, including the number of visits, type of treatment, and expected duration.
- Whether inpatient hospitalization is required.
- Whether the leave is pregnancy-related, with an estimated due date if so.
- A schedule explaining the medical necessity if you need intermittent leave or a reduced work schedule.2Montgomery County Public Schools. MCPS Form 440-35 Certification of Physician
Federal rules require the certification to show enough medical facts to support the need for leave, including symptoms, diagnosis, medication, referrals, and continuing treatment, along with information showing you cannot perform the essential functions of your job.4eCFR. 29 CFR 825.306 – Content of Medical Certification Functional limitations (what you cannot do and for how long) do more work here than extra clinical detail.
Part III: Caring for a Family Member
If you are taking leave to care for a spouse, child, or parent, the family member’s physician completes Part III instead. It asks for:
- The estimated dates you will be away from work to provide care.
- Whether the family member requires inpatient hospitalization.
- Whether the patient needs help with basic medical, hygiene, nutritional, safety, or transportation needs.
- Whether your presence is necessary or beneficial, including for psychological comfort, with a description of the care involved.
- An estimate of how long care is needed, and a schedule if the leave will be intermittent or on a reduced basis.2Montgomery County Public Schools. MCPS Form 440-35 Certification of Physician
Part IV: Provider Authorization
The physician prints and signs their name, dates the form, lists their field of practice or specialization, provides a phone number, and names a contact person the district can reach with questions.
Before you leave the office, read every field. The most common reason certifications bounce back is a blank intermittent-leave schedule, or a provider who writes “unknown” for duration instead of giving a best estimate.
Submitting the Form
Email the completed form to ersc@mcpsmd.org. MCPS directs employees to submit by email and makes clear that only you or your doctor should send it, not a coworker or supervisor, so your medical information stays with the people who need it.1Montgomery County Public Schools. Employee Leave Information If you want help scanning or faxing from your school’s front office, that is your call.
If email will not work, the ERSC accepts faxes at 301-279-3651 or 301-279-3642. Physical mail goes to 45 W. Gude Drive, Suite 1200, Rockville, MD 20850.5Montgomery County Public Schools. About the Employee and Retiree Service Center
Form 440-35 is only the medical certification. You still need to submit Form 430-1 through your principal or supervisor, who forwards it to the ERSC.1Montgomery County Public Schools. Employee Leave Information
The 15-Day Deadline
Once the district asks for a medical certification, you have 15 calendar days to return it. More time is allowed if circumstances beyond your control prevent you from meeting the deadline despite genuine effort, but you have to be actively working on it.6eCFR. 29 CFR 825.305
If the ERSC finds the form incomplete or insufficient, the district must tell you in writing exactly what is missing and give you at least seven calendar days to fix it.6eCFR. 29 CFR 825.305
If you never return a complete certification, the district can deny FMLA protection for the absence. The time off may still come out of your accrued sick or personal leave under MCPS policy, but the federal job-protection guarantee is gone.7U.S. Department of Labor. Fact Sheet 28G – Medical Certification under the Family and Medical Leave Act
If the District Questions the Certification
With a good-faith reason to doubt the validity of a certification, the district can require a second opinion from a different provider at its own expense. That provider cannot be someone the district employs on a regular basis. If the second opinion conflicts with the first, a third provider jointly chosen by you and the district can be brought in, again at district expense, and that third opinion is final and binding.8GovInfo. 29 CFR 825.307 Your FMLA benefits, including group health coverage, continue provisionally while this plays out.
Recertification for Ongoing Conditions
For continuing or recurring conditions, the district can ask for a new Form 440-35, but generally not more often than every 30 days and only in connection with an actual absence. If the original certification put the duration at longer than 30 days, the district has to wait out that minimum before asking again.9eCFR. 29 CFR 825.308
Regardless of the stated duration, the district can request recertification every six months in connection with an absence. For long-term conditions, plan on updating the form roughly twice a year. The district can also ask sooner if you request an extension, if the pattern of absences changes significantly from what the certification described, or if the ERSC receives information suggesting the original certification is no longer accurate.9eCFR. 29 CFR 825.308