To be used by employee who is absent for personal illness, including FMLA absences.
Health care provider: this form must be executed by a physician or practitioner whose method of healing is recognized by the State.
Provider's answers: provide full, complete, and legible answers to all questions. Limit responses to the condition for which the employee is or will be absent from work.
Genetic information: do not provide information about genetic tests, genetic services, or the manifestation of disease or disorder in the employee's family members.
Fitness for duty: the employee must provide the completed fitness-for-duty certification to Human Resources before reporting to their department or unit.
| Question | Answer |
|---|---|
| Form Name | Form P33A |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 83 |
| Avg. time to fill out | 14 min |
| Edition | Revision Effective Date: 1/1/2022 |
| Filing deadline | Within 30 days of foreseeable leave if leave is FMLA qualifying |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | P33A, P-33A, Form P33A, Medical Certificate |
| Official source | Form P33A (Revision Effective Date: 1/1/2022), State of Connecticut Human Resources |
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