NY PFL provides up to 12 weeks of paid leave for bonding, family care, or military exigency

Benefits are 67% of your average weekly wage, capped at 67% of the statewide average weekly wage

PFL can be taken intermittently in full-day increments

Employment / FMLAmoderate

New York Paid Family Leave Request

PFL-1 · New York State

Request for Paid Family Leave in New York. Provides up to 12 weeks of job-protected paid leave to bond with a child, care for a family member, or for a military qualifying exigency.

Form Details

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Where to Submit This Form

📬

Submit to your employer's insurance carrier

Your employer must provide the carrier's information. The form is filed with the carrier, not the employer.

🌐

Some carriers accept electronic submissions through their portal

Filing Deadline

Within 30 days of the start of leave. Benefits are retroactive to the first day of leave if filed within 30 days.

Required Attachments

📎 PFL-1 Request for Paid Family Leave
📎 Supporting documentation depending on leave type: birth certificate, medical certification, military deployment orders
📎 PFL-2 (bonding), PFL-3 (family care), or PFL-4 (military qualifying exigency) as applicable

Processing Time

Insurance carrier must pay or deny within 18 calendar days of receiving a complete request.

What Happens Next

Your employer's insurance carrier will review and approve or deny the claim. If approved, benefits are paid at 67% of your average weekly wage, up to the state cap.

Tips for This Form

✓ NY PFL provides up to 12 weeks of paid leave for bonding, family care, or military exigency
✓ Benefits are 67% of your average weekly wage, capped at 67% of the statewide average weekly wage
✓ PFL can be taken intermittently in full-day increments
✓ If denied, you can request arbitration within 30 days. More info: https://paidfamilyleave.ny.gov/

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

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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)

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

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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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