Form

Paid Family Leave Request - Bond with a Newborn, a Newly Adopted or Fostered Child

Forms: PFL-1 & PFL-2

Who Files: Employee

Where to File: Make a copy of the Request for Paid Family Leave (Form PFL-1) before submitting it to your employer. Send completed forms and supporting documentation to the insurance carrier at the address provided in the PFL-1 Form Part B, Question 13 (the section your employer completed), or send directly to your employer if they are self-insured.

Translated versions: Español | Русский | Polski | 中文 | Italiano | Kreyòl ayisyen | 한국어