The New York Workers’ Compensation Board (the “Board”) has published forms, available on the Board’s website, to be completed and submitted by employees who wish to take PFL. Employers and insurance carriers may choose to use forms different from the ones provided by the Board, but whatever the process, the completed forms must contain the same information. When the need for PFL arises, employers should direct employees to the appropriate forms, based on each employee’s reason for leave: Form PFL-2 is to be used when PFL is sought for child bonding; Forms PFL-3 and PFL-4 (which are combined as a single document on the Board’s website) are to be used when PFL is sought to care for a family member with a serious health condition; and Form PFL-5 is to be used when PFL is sought due a family member’s active military duty or impending active duty abroad. Additionally, regardless of the reason for PFL, each employee who applies for PFL benefits must complete Form PFL-1, which the Board has included within each of the .pdf files accessed through the links above. Employers must complete “Part B” of Form PFL-1.
The Board has published several other forms as well, including a form for employees who elect to opt-out of PFL contributions; forms for employers that elect to provide voluntary coverage for employees for whom PFL benefits are not required by law (Forms PFL-135 and PFL-136); and a form for employers applying to self-insure for PFL benefits (Form DB-150). These forms are also available on the Board’s website.