District of Columbia Application for Family Medical Leave of Absence

State:
Multi-State
Control #:
US-425EM
Format:
Word; 
Rich Text
Instant download

Description

This form may be used by an employee to request leave under the FMLA.
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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.

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.

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.

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.

If you are eligible for Paid Family Leave in the District of Columbia, you may receive a weekly benefit amount which is based on your weekly wages. The current maximum weekly benefit amount is $1,009. The calculation will be based off of a minimum wage of $15.20 per hour.

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

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.

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District of Columbia Application for Family Medical Leave of Absence