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  • Fmla/kcfml Leave Request. Fmla Leave Request Form - Kingcounty

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Date received by department contact Protected Family and Medical Leave Request Form Instructions The employee must submit this form 30 calendar days before leave begins (if the leave is foreseeable).

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The maximum weekly benefits for 2020 – 2023 are: 2023 = $1,427/week. 2022 = $1,327/week. 2021 = $1,206/week.

Your benefits payment is based on your individual average weekly wage, the state average weekly wage for Massachusetts workers, your benefit year, and the type of leave you are taking. In 2022, the maximum weekly benefit is $1,084.31. In 2023, it will increase to $1,129.82.

Starting Jan. 1, 2023, large employers with 25 or more employees will start paying 40% of the total 1% contribution rate and employees will pay 60% of the 1% contribution rate. Employers and employees can use this contributions calculator to estimate how much their contribution will be.

Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience.

Our goal is to process complete applications within three weeks.

Maximum Claim Duration Qualified Washington workers are eligible for: Up to 12 weeks of paid family or medical leave. Up to 16 weeks of leave when family and medical leave are used in combination (e.g., birth parent pregnancy and parental leave).

Paid Family and Medical Leave is funded through premiums paid by both employees and employers. The premium rate is 0.8 percent of each employee's gross wages, not including tips, up to the 2023 Social Security cap ($160,200). Of this, employers with 50+ employees will pay up to 27.24% and employees will pay 72.76%.

Employee Benefits The weekly PFML benefit amount is calculated by ESD and will depend on how much the employee earns in a typical week. In 2021, the maximum weekly benefit was $1,206. In 2022, this increased to $1,327 per week.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232