NY Family Leave Forms


New York State has released the forms employees will need to make a NYS Paid Family Leave Claim. 

claim form the pension departmentPlease click on the hyperlink to download the forms and a highlight sheet.

On the Care For Family Member Form (PFL-1), employees will be required to provide certain information to prove that they need time off to care of a loved one.  They will also need to state whether the leave will be a continuous one or an intermittent one.

Form PFL-1 also contains a section (Part B) which must be completed by the employer and returned to the employee within three business days.  Failure to return Part B back to the employee within the required time, may trigger a penalty or a lawsuit.  Part B notifies the employee of the employee’s last 8 weeks of gross wages. It also notifies the employee of any other Paid Leave taken in the preceding 52 weeks. 

Once the employer has completed Part B and timely returned the Form PFL-1 to the employee, it will then be the employee’s responsibility to submit the form, along with any required supporting documentation, to the employer’s PFL carrier.  

In addition to Form PFL-1, employees must submit proof.  Acceptable proof is as follows:

  • To bond with a newborn, adoption child, or foster child, PFL-2 must be completed.  A birth certificate  or court papers of the adoption are also required. To care for a family member with a serious health condition, form PFL-3 must be completed, as well as certification from a Doctor (Form PFL-4). 
  • PFL-2, PFL-3, and PFL-4 are in the Care For Family Member File.
  • To care for a child(ren) whose parents have been deployed in the military, the military form (PFL-5) must be completed and submitted along with a copy of the member’s covered active duty orders.

In addition to the PFL forms, an Employee Opt Out Form is also available for employees who are being hired on a temporary basis.  The waiver must be provided to all temporary employees.  Temporary is defined as, a Full-Time employee who works 20 or more hours per week but will not work more than 26 consecutive weeks. For Part-Time employees, Temporary is defined as an employee who work less than 20 hours per week and will not work more than 175 days in a 52 consecutive week period.   All other employees must be covered by PFL regardless of whether they have dependents or not or are non U.S. Citizens.  The waiver will be revoked once the employee qualifies for NY Paid Family Leave.