New York Paid Family Leave Certification Forms

New York Paid Family Leave certification forms were recently released by the New York State Workers’ Compensation Board. Depending on the type of leave requested, there are various certification forms to fill out, along with a general application form (known as PFL-1).

Each of the options below contain links to the general application, along with the form for the specific reason for the leave request:

1. The PFL-1 form and PFL-2 Bonding Certification Form are to be used when applying for PFL to bond with a newborn or a newly adopted or fostered child
2. The PFL-1 form and PFL-3 Release of Personal Health Information Form, along with the PFL-4 Health Care Provider Certification Form, are to be used when applying for PFL to care for a family member with a serious health condition
3. The PFL-1 form and PFL-5 Military Qualifying Event Form are to be used when applying for a PFL because of a family member’s covered active military duty or impending covered active duty

Read more information about how employees can use PFL, and contact us at (518) 373-4111 for more information.