Paid Family Leave Forms

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If you have difficulty in obtaining the Paid Family Leave forms or need help in completing these forms, please contact the PFL Helpline at (844)-337-6303.

All Paid Family Leave Forms

21 results found

Employer, Employer

PFL Model Language for Employee Materials (2025)

Learn more about PFL Model Language for Employee Materials (2025)

Employer, Employer

2025 PFL Payroll Deduction Notice

Learn more about 2025 PFL Payroll Deduction Notice

Employer, Insurance Carrier

Form PFL-271S - PFL Statement of Rights

Translated versions available

Learn more about Form PFL-271S - PFL Statement of Rights

Discrimination

Form PFL-32-D - Section 32 Waiver Agreement

Learn more about Form PFL-32-D - Section 32 Waiver Agreement

Employer, Discrimination

Form PFL-300.5-D - Stipulation for PFL Discrimination Claim

Learn more about Form PFL-300.5-D - Stipulation for PFL Discrimination Claim

Employee

Form PFL-820.1 - Supplement to Certificate of Insurance

Learn more about Form PFL-820.1 - Supplement to Certificate of Insurance

Insurance Carrier

Form PFL-CR-001 - PFL Claim Denial Template

Learn more about Form PFL-CR-001 - PFL Claim Denial Template

Employer, Discrimination

Form PFL-DC-130 - Employer's Response to PFL Discrimination Compl...

Learn more about Form PFL-DC-130 - Employer's Response to PFL Discrimination Complaint

Employee, Employer, Insurance Carrier

Form LAC-1 - Language Access Complaint Form

Learn more about Form LAC-1 - Language Access Complaint Form

COVID-19, Employee

Forms PFL-1 and SCOVID19 - Request for COVID-19 Quarantine DB/PFL...

Learn more about Forms PFL-1 and SCOVID19 - Request for COVID-19 Quarantine DB/PFL - Self

Paid Family Leave Forms

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