MA PFML provides up to 20 weeks for medical leave and 12 weeks for family leave (26 weeks combined max)

Benefits are approximately 80% of average weekly wage up to 50% of the state average, then 50% of the remainder

Job protection is included — your employer must hold your position or an equivalent one

Employment / FMLAmoderate

Massachusetts Paid Family and Medical Leave Application

MA PFML · Massachusetts Department of Family and Medical Leave

Application for Paid Family and Medical Leave in Massachusetts. Covers medical leave, family leave for bonding or caregiving, and military-related qualifying exigencies.

Form Details

Total fields: 34
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Filled by: patient
Frequency: per incident
State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

Mass.gov PFML portal (recommended)

https://paidleave.mass.gov/

File through the Massachusetts Department of Family and Medical Leave portal.

Filing Deadline

File within 30 days of the start of leave. Claims can be filed up to 60 days in advance of anticipated leave.

Required Attachments

📎 Medical certification from your healthcare provider (for medical leave)
📎 Documentation of qualifying reason (bonding: birth certificate; caregiving: medical cert for family member)
📎 Employer information

Processing Time

Approximately 14 business days from receipt of a complete application.

What Happens Next

DFML will issue a determination. If approved, benefits are based on your wages (up to 80% of average weekly wage, up to the state cap).

Tips for This Form

✓ MA PFML provides up to 20 weeks for medical leave and 12 weeks for family leave (26 weeks combined max)
✓ Benefits are approximately 80% of average weekly wage up to 50% of the state average, then 50% of the remainder
✓ Job protection is included — your employer must hold your position or an equivalent one
✓ More info: https://www.mass.gov/pfml

More Employment / FMLA Forms

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WH-380-E · U.S. Department of Labor

Certification of Health Care Provider for Employee's Serious Health Condition. Medical certification for FMLA leave for the employee's own condition.

FMLA Certification - Family Member's Serious Health Condition

WH-380-F · U.S. Department of Labor

Certification of Health Care Provider for Family Member's Serious Health Condition. Medical certification when employee needs leave to care for a family member.

FMLA Notice of Eligibility and Rights & Responsibilities

WH-381 · U.S. Department of Labor

Notice of Eligibility and Rights & Responsibilities. Employer must provide within 5 business days of FMLA leave request, stating whether employee is eligible.

FMLA Designation Notice

WH-382 · U.S. Department of Labor

Designation Notice. Employer designates leave as FMLA-qualifying or denies it. Must be provided within 5 business days of receiving sufficient certification.

FMLA Certification - Qualifying Exigency (Military)

WH-384 · U.S. Department of Labor

Certification of Qualifying Exigency for Military Family Leave. For leave due to a covered family member's active duty or call to active duty.

FMLA Certification - Serious Injury/Illness of Servicemember

WH-385 · U.S. Department of Labor

Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (current servicemember).

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Massachusetts Department of Family and Medical Leave or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.