Tip for WA PFML Application

WA PFML provides up to 12 weeks for medical leave, 12 weeks for family leave, or 16 weeks combined

Tip for WA PFML Application

Up to 18 weeks for pregnancy complications combined with bonding leave

Tip for WA PFML Application

Benefits range from about 75-90% of your weekly wage, depending on income

Employment / FMLAmoderate

Washington Paid Family and Medical Leave Application

WA PFML Application · Washington Employment Security Department

Application for Paid Family and Medical Leave in Washington State. Requires 820 hours worked in WA in the prior year. Accepts FMLA certification forms or other medical documentation.

Form Details

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Where to Submit This Form

🌐

Paid Leave WA portal (recommended)

https://paidleave.wa.gov/apply/

Apply online through the Washington Paid Family and Medical Leave portal.

Filing Deadline

File no earlier than the first day of leave but do not delay — benefits are not retroactive beyond the application date.

Required Attachments

📎 Medical certification from your healthcare provider (for medical leave)
📎 Proof of family relationship (for family leave, e.g., birth certificate, marriage certificate)
📎 Employer information (name, address, dates of employment)

Processing Time

Approximately 2-3 weeks for an initial determination.

What Happens Next

ESD will review your application and medical certification. If approved, weekly benefit payments are based on your wages (up to 90% for lower-income workers).

Tips for This Form

✓ WA PFML provides up to 12 weeks for medical leave, 12 weeks for family leave, or 16 weeks combined
✓ Up to 18 weeks for pregnancy complications combined with bonding leave
✓ Benefits range from about 75-90% of your weekly wage, depending on income
✓ Apply at: https://paidleave.wa.gov/

More Employment / FMLA Forms

FMLA Certification - Employee's Serious Health Condition

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 Washington Employment Security Department 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.