Forms
| Title | Purpose | Action |
|---|---|---|
| Colorado Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Colorado Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Colorado Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Colorado Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave for your own serious health condition. |
Download |
| Colorado Paid Family and Medical Leave Safe Leave Attestation | Used to attest the need for Safe Leave, as defined on the form, when submitting a request for CO PFML Safe Leave benefits. |
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| Connecticut Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Connecticut Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Connecticut Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Connecticut Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave for your own serious health condition. |
Download |
| EFT Setup for Long Term Disability Claim Payments (All states except NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
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| EFT Setup for Long Term Disability Claim Payments (NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
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| Long Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York. |
Download |
| Long Term Disability Claim Packet (NY) | Use this packet to file a claim for a Long Term Disability plan issued in the state of New York. |
Download |
| Massachusetts Paid Family and Medical Leave Bonding Leave Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Massachusetts Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Massachusetts Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Massachusetts Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave for your own serious health condition. |
Download |
| Oregon Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Oregon Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Oregon Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Oregon Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Oregon Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Oregon Paid Family and Medical Leave for your own serious health condition. |
Download |
| Short Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Short Term Disability plan issued outside of the states of New York. |
Download |
| Short Term Disability Claim Packet (NY) | Use this packet to file a claim for a Short Term Disability plan issued in the state of New York. |
Download |
| State Disability Claim Packet (NJ) | Use this packet to file a claim through a New Jersey State Disability plan. |
Download |
| State Disability Claim Packet (NY) | Use this packet to file a claim through a New York State Disability plan. |
Download |
| Washington Paid Family and Medical Leave Bonding Leave Packet | Complete this packet to apply for Washington Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Washington Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Washington Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Washington Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Washington Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Washington Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Washington Paid Family and Medical Leave for your own serious health condition. |
Download |