Paid Family Leave Employer and Employee Forms

TOP Paid Family Leave Employer and Employee Forms
Employee

Employee Paid Family Leave Opt-Out and Waiver of Benefits

If an employee does not expect to work long enough to qualify for Paid Family Leave (a seasonal worker, for example), the employee may opt out of Paid Family Leave by completing the Waiver of Benefits Form.

Where to File: With the employee’s employer.

Bond with a Newborn, a Newly Adopted or Fostered Child
Bond with a Newborn, a Newly Adopted or Fostered Child

Employee is requesting Paid Family Leave to take time off to bond with a newly born, adopted, or fostered child.

Where to File: Send completed forms and supporting documentation to insurance carrier.

Care for a Family Member with Serious Health Condition
Care for a Family Member with Serious Health Condition

Employee is requesting Paid Family Leave to take time off to care for a family member with a serious health condition.

Where to File: Send completed forms and supporting documentation to insurance carrier.

Assist Families in Connection with a Military Deployment
Assist Families in Connection with a Military Deployment

Employee is requesting Paid Family Leave to help relieve family pressures when someone is called to active military service abroad.

Where to File: Send completed forms and supporting documentation to insurance carrier.

Employer
Employer

Employer’s Application for Voluntary Coverage (No Employee Contribution) (PFL-135)

Employers exempt from providing mandatory Paid Family Leave may provide voluntary Paid Family Leave by completing PFL-135 (if no employee contribution is required).

Where to File: Bureau of Compliance, 328 State Street, Schenectady, NY 12305

 

Employer’s Application for Voluntary Coverage (Employee Contribution Required) (PFL-136)
Employer’s Application for Voluntary Coverage (Employee Contribution Required) (PFL-136)

Employers exempt from providing mandatory Paid Family Leave may provide voluntary Paid Family Leave by completing PFL-136 (if they will be requiring an employee contribution).

Where to File: Bureau of Compliance, 328 State Street, Schenectady, NY 12305

 

Assistance
Assistance
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If you have difficulty in obtaining the Paid Family Leave forms or need help in completing these forms, please contact the PFL Helpline at (844)-337-6303. 

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