Washington Request for Extended Personal Leave

State:
Multi-State
Control #:
US-300EM
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an employee to request an extended leave of absence.
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How to fill out Request For Extended Personal Leave?

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FAQ

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.

All parents can receive up to 12 weeks of bonding leave in the first year after your child's birth or placement. If you give birth you can be eligible for up to 16 weeks of combined medical and family leave.

First submit the medical leave application and documentation.Once you have received a determination on your medical leave, you can submit an application and documentation for family/bonding leave in your Paid Leave account.

Paid Family Leave (PFL) provides working Californians up to eight weeks of partial pay to take time off work to care for a seriously ill family member, bond with a new child, or participate in a qualifying military event.

Carryover of paid sick leaveAt a minimum, employees must carry over their accrued, unused paid sick leave balances of 40 hours or less from one accrual year to the next.

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.

How do I request an extension on my leave? If you need to update your leave dates, you can submit a Request for Review in your Paid Leave account. You will also need to upload: a new Certification of Serious Health Condition form with the extended dates for medical leave.

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.

Your doctor will determine when you are cleared from disability. While this is typically 6 or 8 weeks after birth, should you have any complications physical or mental (i.e. postpartum depression) your doctor can certify an extension to your PDL, and your SDI benefits will be extended along with it.

Family leave (includes bonding leave and military family leave) You can take paid time off to care for a family member with a serious health condition, or if you're bonding with a new baby or child in your family.

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Washington Request for Extended Personal Leave