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

Who Files: Employee, followed by an employer’s response

Where to File:  All three pages of this form and any attachments must be sent to the employer as well as the address below. An employer’s response, 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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