Massachusetts Request for Vacation Extension

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Multi-State
Control #:
US-223EM
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Word; 
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Description

This form is used by an employee to request an extension of vacation leave.

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FAQ

There is no formal provision in the FMLA for extended leave beyond 12 weeks. However, it is possible for workers to negotiate an extension on a case-by-case basis by discussing their situation with their employer and requesting additional unpaid leave during a family or medical crisis.

The Massachusetts Department of Family and Medical Leave has announced the contribution rates for Paid Family and Medical Leave (PFML) effective January 1, 2022. The PFML contribution rate is set each year and applies up to the Social Security wage limit, or $142,800 for 2021 and $147,000 for 2022.

The Massachusetts Paid Family Medical Leave (Massachusetts FLI) became effective on October 1, 2019. Note: You may find it useful to review the Guide to Paid Family and Medical Leave for Massachusetts Employers from the Massachusetts Paid Family Medical Leave web page.

Application of Leave Extension Dear Sir/Madam, I am saying this from regret feeling that I was on leave for some days, but the issue for which I was on leave is still to be unsettled. I am working on the issue, and it will be determined soon. It needs some more days so, please grant me leave for four more days.

Another option is to extend your claim through a verbal certification by calling 1-877-238-4373 if you have not returned to work or had a break in certification from your current bonding period. For PFL military assist claims, if you wish to extend your claim, you may order another DE 2501F.

If you need to extend your leave, you must call the Contact Center to request an extension at least 14 calendar days before the expiration of your original leave. You can call the Department's Contact Center at (833) 344-7365 to request an extension and send us your documentation as soon as it is available.

Dear Mr./Ms. (Name of recipient), I am writing to inform you that I find myself unable to return to work on (date), and must request for a leave extension.

Most Massachusetts employees are eligible for up to 26 weeks of combined family and medical leave per benefit year. You can take leave for a qualifying reason.

I am writing this letter to inform you about my type of leave leave status. Currently, I am on leave for original leave duration days from start date to original end date. Explain the reason for the extension. Due to this, I need to extend my leave for another number of days until new end date.

You may also order another Claim for Paid Family Leave (PFL) Benefits (DE 2501F). Another option is to extend your claim through a verbal certification by calling 1-877-238-4373 if you have not returned to work or had a break in certification from your current bonding period.

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Massachusetts Request for Vacation Extension