This form is an application for Family and Medical Leave. It is to be filled out by an employee who is requesting a leave of absence.
District of Columbia Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Employee Application For 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.
In D.C., employers with 20 or more employees must allow eligible employees to take up to 16 weeks of unpaid family leave plus 16 weeks of unpaid medical leave in any 24-month period. Medical leave is for the employee's own serious health condition.
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.
DC workers can now apply for paid family leave. The Paid Leave Act provides up to: 2 weeks to care for your pregnancy. 8 weeks to bond with a new child.
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.
But instead of a gradual climb, now those changes will come all at once: Starting this year, eligible workers will be provided with 12 weeks of paid parental, family and medical leave with a cap of 12 weeks in a year, according to a letter from then-acting chief financial officer Fitzroy Lee.
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.
You are eligible for Paid Family Leave benefits if you: Spend more than 50% of your time working in DC. Eligible workers must spend a majority of their time working the Districtincluding teleworking or telecommutingfor a covered employer, and must have completed that work during the year prior to needing leave.
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.
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.
