Paid Family Leave: Forms for Employers

TOP Paid Family Leave: Forms for Employers
Overview
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Employer Forms
Employer Forms

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

Statement of Rights for Paid Family Leave (PFL-271S)
Statement of Rights for Paid Family Leave (PFL-271S)

Employers must provide the Employee Statement of Rights (form PFL-271s) to employees when they take Paid Family Leave or take time off from work for a Paid Family Leave qualifying event, but have not requested Paid Family Leave. Employers may also provide this form to all employees to educate them about Paid Family Leave.

Where to File: This form is not filed.

Employer's Response to Paid Family Leave Discrimination/Retaliation Complaint (PFL-DC-130)
Employer's Response to Paid Family Leave Discrimination/Retaliation Complaint (PFL-DC-130)

Within 30 days of receiving a Notice of Paid Family Leave Discrimination/Retaliation Complaint (Form PFL-DC-129) from the Board, employers must complete and submit this form (PFL-DC-130) to the Board. 

Where to File: Send the completed form to:

Paid Family Leave
PO Box 9030
Endicott, NY 13761-9030

Section 32 Waiver Agreement: Paid Family Leave Discrimination/Retaliation Claim (PFL-32-D)
Section 32 Waiver Agreement: Paid Family Leave Discrimination/Retaliation Claim (PFL-32-D)

Form PFL-32-D is submitted when an employee, employer, and any representatives mutually agree to specific terms in order to settle a discrimination claim. 

Where to File: Send the completed form to: 

Paid Family Leave
PO Box 9030
Endicott, NY 13761-9030

Stipulation for Paid Family Leave Discrimination/Retaliation Claim (PFL-300.5-D)
Stipulation for Paid Family Leave Discrimination/Retaliation Claim (PFL-300.5-D)

To be used for stipulations to uncontested facts or proposed findings, pursuant to 12NYCRR 300.5.

Where to File: Send the completed form to the address below. 

Paid Family Leave
PO Box 9030
Endicott, NY 13761-9030

Additional Forms
Additional Forms
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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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