How to Fill out Paid Family Leave Form in Virginia

Paid family leave is a form of partial wage loss replacement that allows workers to take job-protected time off to bond with a new child or care for a critically ill family member. Paid family leave may be offered as part of an employee’s benefits program or it may be mandated under state law. 

Although paid family leave is not guaranteed under federal law, it is important to note that the Family and Medical Leave Act (FMLA) does require employers with 50 or more employees to grant job-protected, unpaid leave to workers. Here, our Virginia leave of absence lawyers explains what you need to know about filling out a paid family leave form.

Request for Paid Family Leave Form PFL-1 Instructions

To ensure that an employee is able to take paid family leave and return to work without problems, it is crucial that the proper information is provided by all parties. Indeed, employers and employees need to work together to complete and submit a paid family leave application. Both parties have important responsibilities. Here is an overview of the information that employees and employers should be prepared to provide: 

Part A-Employee Details

To request paid family leave, an employee needs to fill out Part A of the PFL-1 form. All items on the documents are needed unless they are labeled optional. After completing the required section, the employee should give the form to their employer to finish Part B. Part A of the PFL-1 form has the following parts that need to be completed by the employee:

• Employee’s official names
• Other last names the employee has worked with
• Street address, city, state, zip code, and country (if not the U.S.)
• The Social Security Number or TIN of the employee
• Date of birth
• Primary phone number
• Preferred email ID while on Paid Family Leave
• Gender
• Preferred language
• Ethnicity or race (optional)
• Reason for requesting for Paid Family Leave: bond with the child, care for a family member, or military qualifying event
• The relationship between the employee and the family member: child, spouse, domestic partner, parents, parents-in-law, grandparents, or grandchildren.
• Whether the Paid Family Leave will be for a continuous duration and/or periodic
• Explanation of the notice is being given less than 30 days in advance to the employer
• The name of the business
• Date of hire
• Work location
• Average gross weekly wage
• Phone number to contact for the PFL request
• If the employee has two employers
• If the employer has more than one employer, whether they are taking paid family leave from the other employer
• If the employee is getting Workers’ Compensation Lost Wage Benefits at the current time
• Signature and date of signing
• Confirm you are submitting the form in advance by ticking on the checkbox

Part B-Employer Details

After completing Part B of the Form PFL-1, the employer should return it to the applicant within three business days. The employee will then take the form and all additional documentation to the employer’s insurance carrier. It’s essential for the employee to retain a copy of every submitted document for personal records. Here are the details an employer is required to complete on the Part B section of the PFL-1 form:

• The full legal name of the company and mailing address
• Employer’s FEIN
• Standard Industrial Classification Code
• Contact name for inquiries related to Paid Family Leave
• Contact phone number of employer
• The email address of the employer
• Date of the hire of an employee
• Employee’s occupation
• Details of the last eight weeks of the employee’s gross wages and average gross weekly wage
• If the employee got or will get full wages on paid family leave if the employer will ask for reimbursement
• If the employee has gone on leave for NYS Disability, PFL, or both over the past 52 weeks
• State the number of weeks and days the employee has taken for Disability or paid family leave in the past 52 weeks
• If the employee is taking FMLA together with PFL
• PFL insurance provider’s name and address
• PFL insurance provider’s phone number
• PFL policy number
• Employer’s declaration and signature

Call Our Virginia Leave of Absence Attorneys for Immediate Assistance

At Pierce / Jewett, our Virginia paid family leave attorneys are skilled, knowledgeable advocates for our clients. We have extensive experience representing both employers and employees. If you have any questions or concerns about paid family leave, we are ready to help. To set up a confidential initial consultation, please contact us today. With office locations in Norfolk and Richmond, we serve communities in Hampton Roads and throughout Central Virginia. 

CALL NOW: 757-624-9323

Disclaimer: This article contains general information. It should not be taken as legal advice. No attorney-client relationship has been created. If you have specific questions about your rights or your options, you should speak to an experienced lawyer about your individual case.