FFCRA Paid Leave Request Form

Updated 8/16/2020

Based on the latest IRS and DOL guidance, we have prepared a sample form to be used when employees request paid leave under the Families First Coronavirus Response Act (FFCRA), which goes into effect April 1.  Please see the attached Template FFCRA COVID-19 Leave Request Form, and please review our notes in the margins included for your information.  As explained in the notes, you may wish to customize the Leave Request Form based on the decisions you make as an employer with respect to permitting intermittent use of FFCRA leave. 

For detailed guidance from the IRS regarding COVID-19-related tax credits for required paid leave under the FFCRA, please review the FAQs found here. Please do not hesitate to contact us if you have any questions or concerns related to your obligations under the Families First Coronavirus Response Act.