nygov-logo
Skip to main content

Paid Family Leave

  • Employees
    • Employees
    • How to Apply
    • Eligibility
    • Bonding Leave
    • Family Care Leave
    • Military Family Support
    • Benefits
    • Cost and Deductions
    • Your Rights and Protections
  • Employers
    • Employers
    • Employer Responsibilities and Resources
    • Handling Requests
    • Public Employers
    • Self-Employed Individuals
    • Out-of-State Employers
  • Health Care Providers
    • Health Care Providers
    • Your Role
  • PFL and Other Benefits
    • PFL and Other Benefits
    • FMLA
    • Short-term Disability
    • Workers' Compensation
    • Parental Leave
    • Sick/Vacation Time
    • Unapproved Leave
    • Unemployment Insurance
  • Forms
    • Forms
    • COVID-19 Forms
    • Employee Forms
    • Employer Forms
    • Discrimination Forms
    • Insurance Carrier Forms
  • COVID-19
  • Contact Us

Form PFL-136 - Employer Application for Voluntary Coverage (Contributions)

Form PFL-136 - Employer Application for Voluntary Coverage (Contributions) [PDF]

Paid Family Leave
  • Get Paid Family Leave Updates
  • Language Access Policy
  • Accessibility
  • NYS Workers' Compensation Board
  • Site Map

CONNECT WITH US

  • FACEBOOK
  • INSTAGRAM
  • LINKEDIN
  • MAIL
  • TWITTER
  • YOUTUBE