Emergency Paid Sick and Emergency Paid FMLA Forms and Administrative Processes
** April 1, 2021 Changes ***
On April 1, 2021 offering ESick and EFMLA is OPTIONAL to employers. To opt-out of offering ESick and EFMLA, please download, sign, and submit the form below.
Emergency Paid FMLA Administration
(EFMLA)
- EFMLA Processing Instructions
- Employee Paid Leave Request form for Emergency FLMA
- Employer Approval / Denial form for Emergency Paid FMLA
Emergency Paid FMLA At-A-Glance
- Employer receives an immediate tax credit against FICA
- Provides up to 12 weeks of job-protected leave
- first 2 weeks could be unpaid
- up to 10 weeks are paid.
- Applies to employees who have been employed for at least 30 calendar days
- Paid portion no less than 2/3rds of the employee’s regular rate of pay
- Paid number of hours must follow the employee normally scheduled work.
- Caps the amount of the paid leave, per employee, no more than $200 per day or $10,000 in the aggregate.
Emergency Paid Sick Leave Administration
(ESICK)
- ESICK Processing Instructions
- Employee Paid Leave Request form for Emergency Sick Leave
- Employer Approval /Denial form for Emergency Paid Sick Leave
Emergency Paid Sick At-A-Glance
- Two weeks (up to 80 hours) of paid sick leave at the employee’s regular rate of pay where the employee is unable to work because the employee is quarantined and/or experiencing COVID-19 symptoms and seeking a medical diagnosis; or
- Two weeks (up to 80 hours) of paid sick leave at two-thirds the employee’s regular rate of pay because the employee is unable to work because of a bona fide need to care for an individual subject to quarantine, or care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19, and/or the employee is experiencing a substantially similar condition.
- Applies to employees who have been employed for at least 1 day