New York Paid Family Leave

State resources

The state of New York has committed to publishing forms and notices to support employers’ Paid Family Leave (PFL) plan administration.  We have provided links to key state forms below. Additional links will be added as the state releases forms.

You should direct all questions regarding state-issued forms to the state’s PFL Hotline (844)-337-6303.

Employee forms:

  1. Employee Paid Family Leave Opt-Out and Waiver of Benefits. Employers should provide this form to employees that qualify for a waiver of coverage. Employers are expected to maintain a copy of an employee’s form for the duration of the employee’s employment. 
    Published October 3, 2017
     

Employer forms:         

  1. Employer’s Application for Voluntary Coverage (No Employee Contribution) (PFL-135). Public employers electing to offer PFL coverage at no cost to their New York employees must complete and return this form to the Chair. The employer is required to provide Notice to the Chair and its impacted employees by December 1, 2017 for a January 1, 2018 effective date. 
    Published October 3, 2017
  2. Employer’s Application for Voluntary Coverage (Employee Contribution Required) (PFL-136). Public employers electing to offer PFL coverage and requiring their New York employees to bear the cost must complete and return this form to the Chair. The employer is required to provide Notice to the Chair by December 1, 2017 for a January 1, 2018 effective date (additional lead time should be expected to meet this deadline since the employer must notify impacted employees and at least 50% of those employees must agree to contribute before providing notice to the Chair).


Other New York state Paid Family Leave resources:

  1. New York state consumer page 
  2. State forms 
  3. Workers’ Compensation Board Final Regulations
  4. Department of Financial Services (DFS) Tax Guidance 
  5. DFS Premium Rate Guidance  

In New York, insurance products (policy series GL111, GL3001) are issued by Lincoln Life & Annuity Company of New York, a Lincoln Financial Group® company. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. Limitations and exclusions apply.