District of Columbia Family and Medical Leave Request Form

State:
Multi-State
Control #:
US-266EM
Format:
Word; 
Rich Text
Instant download

Description

An employee may use this form to request leave under the FMLA.
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  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form

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FAQ

We encourage you to use our benefits application portal to file a claim. If you are unable to apply online, please call our contact center at (202) 899-3700. Click to download our PFL Employee Handbook for additional information about qualifying events and the program.

We encourage you to use our benefits application portal to file a claim. If you are unable to apply online, please call our contact center at (202) 899-3700. Click to download our PFL Employee Handbook for additional information about qualifying events and the program.

An employee is eligible under the Act if she or he has been employed by the employer for at least one year without a break in service, and worked at least 1,000 hours during the 12 month period immediately preceding the requested leave.

As explained in Chapter 2, there is a 7-day waiting period for benefits. Benefit payments occur on a schedule every two weeks. You will always receive payment for your Paid Family Leave benefits after the week for which benefits were payable to you and during which you took leave.

A: No, DC Paid Family Leave does not provide job protection. Other laws, such as the Family and Medical Leave Act (FMLA), provide job protection when workers take Paid Family Leave. It is important for you to notify your employer before applying for leave and to determine a schedule that works.

DC Paid Family Leave provides wage replacement of 90% of wages up to 1.5 times DC's minimum wage and 50% of wages above 1.5 times DC's minimum wage. The maximum weekly benefit amount is $1,000.

1, 2021, the D.C. City Council expanded the local Paid Family Leave law and the D.C. Family and Medical Leave Act (D.C. FMLA). The new laws entitle employees to three times as much paid medical leave and a new category of paid prenatal leave. The modifications also expand the group of employees eligible for D.C. FMLA.

How Much Can I Receive in Parental Leave Benefits? DC Paid Family Leave provides wage replacement of 90% of wages up to 1.5 times DC's minimum wage and 50% of wages above 1.5 times DC's minimum wage. The maximum weekly benefit amount is $1,000.

An employee is eligible under the Act if she or he has been employed by the employer for at least one year without a break in service, and worked at least 1,000 hours during the 12 month period immediately preceding the requested leave.

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District of Columbia Family and Medical Leave Request Form