FMLA Forms Hhc

Employee Resources Center

https://ess.nychhc.org/fmla.html

Use BOTH these forms to Request a Leave for Employee to Care for a Family Member with a Serious Health Condition. (spouse, child under age 18, child age 18 or older but incapable of self-care because of a physical or mental disability, or parent of the employee) Request for FMLA, Child Care Leave and/or Military Leave Form SR-71 (NEW FORM)
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NEW YORK CITY HEALTH HOSPITALS Request For Leave Or

https://ess.nychhc.org/uploads/SR_70.pdf

(Use HHC 996 for Worker’s Compensation) … (FMLA) entitles eligible HHC employees to up to 12 weeks of leave in a 12-month period for child care upon the birth, adoption or foster care placement of a child; and for the serious health condition of the employee or covered family members. In addition, eligible employees with family members in the military are entitled to two …
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How To Apply For FMLA Everything You Need To Know

https://www.upcounsel.com/how-to-apply-for-fmla

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Request For Leave Under The Family And Medical Leave Act

https://www.uft.org/files/attachments/fmla-application.pdf

˜ FMLA leaves may be approved at the local level by the organization head. Applications may be referred to the Division of Human Resources, Medical, Leaves, and Benefits Office for clarification, where necessary. ˜ Any paid leave for a FMLA qualifying reason, will be counted against annual FMLA leave entitlements.
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Certification Of Health Care Provider For Employee S

https://ess.nychhc.org/uploads/Certification_of_Health_Care_Provider_for_Employees_Serious_Health_Condition_(FMLA)_Form_2677.pdf

Leaves at [email protected]. Incomplete forms will not be processed. FMLA runs concurrently with all other eligible leaves. Please note some Group 12 employees may be eligible for Paid Family Leave (PFL) for Bonding, and the serious health condition of a family member processed by third party administrator AbSolve at 800-401-2691. Additional …
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Request For FMLA Child Care And Military Leave

https://ess.nychhc.org/uploads/HRSS_Request_for_Leave_of_Absence_Form_SR-71.pdf

FMLA Qualifying Reasons: (Check which reason applies) An eligible employee may request up to twelve (12) weeks of unpaid job-protected leave for the serious health condition of: Employee Birth of a child Employee’s spouse (or domestic partner) Foster care placement of a child Parent(s); or Adoption of a child Child (under 18 years of age) Child over 18, if incapable of self-care due to …
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Family Medical Leave Employer Instructions And Forms

https://download.paychex.com/pas_pbs/formfiles/pbs_fmla.pdf

Employer Instructions and Forms When you become aware of an employee’s need for family or medical leave* complete the following: Provide the employee with a Request for Family/Medical Leave under the FMLA form. Have the employee complete the form and return it to their supervisor or other designated company representative for approval or denial of leave. After …
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Employee Service Center Forms Links NYC Health

https://ess.nychhc.org/forms.html

Employee Resources Center; Forms; Employee Service Center Forms/Links. Click below for up-to-date forms and documents for use in submitting address or name changes, W4 forms for adjusting withholding status when needed, observance of public holidays, requesting time …
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