Paid Family Leave Forms

Forms

Assistance with Forms

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

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Insurance Carrier

Form PFL-CR-001 - PFL Claim Denial Template

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

Employee, Employer, Insurance Carrier

Form LAC-1 - Language Access Complaint Form

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

Employer, Insurance Carrier

Form PFL-271S - PFL Statement of Rights (2023)

Translated versions available

Learn more about Form PFL-271S - PFL Statement of Rights (2023)

Insurance Carrier

Notice of Compliance

Form PFL-120

Learn more about Notice of Compliance

Paid Family Leave Forms

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