Form

Form PFL-DC-119 - Formal Request for Reinstatement Regarding Paid Family Leave

Who Files: Employee

Where to File:  All three pages of this form and any attachments must be sent to the employee, the employee's attorney (if one is listed on this form) and to:

Paid Family Leave

PO Box 9030

Endicott, NY 13761-9030.

 

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