Get Request For Covid-19 Quarantine Db/pflself - New York State

This guide provides clear instructions on completing the Request For COVID-19 Quarantine DB/PFL Self form for individuals in New York State seeking Paid Family Leave and/or disability benefits due to COVID-19 quarantine or isolation. The step-by-step directions ensure that users can navigate the process with ease and confidence.

Follow the steps to accurately fill out the form.

1. Click ‘Get Form’ button to acquire the form and open it in the editor.
2. Complete Sections 1 and 2 of the Request For COVID-19 Quarantine DB/PFL Self form. Provide your reason for requesting Paid Family Leave, which is due to COVID-19 quarantine or isolation.
3. Fill out Section 2, known as the Employee Attestation, and ensure to sign and date the form, affirming that you are unable to work during the quarantine period.
4. Once you have filled out your sections, give the completed form to your employer so they can complete Section 3, the Employer Attestation, within three business days.
5. Obtain any mandatory or precautionary order of quarantine or isolation and attach this document to your request.
6. Submit all completed forms, along with the quarantine or isolation order, to your employer’s Paid Family Leave insurance carrier as indicated on Part B of the Request For Paid Family Leave form.
7. Keep a copy of all submitted forms for your records and monitor your request, as the insurance carrier must respond within 18 calendar days.

Complete your documents online today to ensure a smooth application process for your Paid Family Leave and disability benefits.