FORM

PFL-136  - Employer's Application for Voluntary Coverage for Class of Employees For Whom Paid Family Leave Benefits Are Not Required by Law (Employee Contribution Required)

Who Files: Employer

Where to File:

Workers' Compensation Board

Bureau of Compliance

PO Box 5200

Binghamton, NY 13902-5200

or

email to [email protected]

When to File: To voluntarily cover employees for whom Paid Family Leave Benefits are not required under the Law with employee contributions to the cost of the coverage.