Form

Paid Family Leave Request - Care for a Family Member with Serious Health Condition

Forms: PFL-1, PFL-3, PFL-4 

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