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.
Massachusetts Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word;
Rich Text
Instant download
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FAQ
Your benefits payment is based on your individual average weekly wage, the state average weekly wage for Massachusetts workers, and the type of leave you are taking. The maximum weekly benefit is $1,084.31.
FMLA v. PFML: As stated, PFML provides paid leave to all eligible Massachusetts employees while FMLA provides unpaid job protected leave only for employers with 50 or more employees or smaller employers that choose to participate.
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.
Like employers in every state, Massachusetts employers must follow the federal Family and Medical Leave Act (FMLA), which allows eligible employees to take unpaid leave for certain reasons. Once an employee's FMLA leave is over, the employee has the right to be reinstated to his or her position.
When the Department has enough information to consider your application complete, they will begin review and make a decision within 14 calendar days.
Most benefit payments are issued within two weeks after the EDD receives a properly completed claim online or by mail.
If you are applying for military-related paid family leave benefits, or if you are currently self-employed or unemployed, please call the Department's Contact Center at (833) 344-7365 to begin your application.
Massachusetts employers are subject to the FMLA if they have at least 50 employees for at least 20 weeks in the current or previous year. Employees are eligible for FMLA leave if: they have worked for the company for at least a year. they worked at least 1,250 hours during the previous year, and.
