MD PFML provides up to 12 weeks of paid leave for medical and family reasons

Benefits are expected to be up to 90% of average weekly wage for lower-income workers

Check https://www.dol.state.md.us/ for the latest program updates and benefit start dates

Employment / FMLAmoderate

Maryland Family and Medical Leave Insurance Application

MD PFML · Maryland Department of Labor

Application for Maryland's Family and Medical Leave Insurance program. Covers medical leave, family caregiving, bonding, and qualifying exigencies.

Form Details

Total fields: 34
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State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

Maryland PFML portal

https://www.dol.state.md.us/

Maryland's PFML program begins benefits in mid-2026. Check the Maryland DOL website for portal information.

📬

Mail to Maryland Department of Labor

Submission details will be published as the program launches.

Filing Deadline

Within 30 days of the start of leave (subject to final regulations).

Required Attachments

📎 Medical certification from your healthcare provider
📎 Documentation of qualifying leave event
📎 Employer information and wage history

Processing Time

Expected 2-4 weeks based on similar state programs.

What Happens Next

Maryland DOL will review and issue a determination. Benefits will be based on wages, similar to other state PFML programs.

Tips for This Form

✓ MD PFML provides up to 12 weeks of paid leave for medical and family reasons
✓ Benefits are expected to be up to 90% of average weekly wage for lower-income workers
✓ Check https://www.dol.state.md.us/ for the latest program updates and benefit start dates
✓ Employer contributions began in 2025; benefits are expected to be payable starting mid-2026

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.

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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 Maryland Department of Labor 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.