Families First Leave Request Form

The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19. These provisions will apply from April 1, 2020 through December 31, 2020.

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If you would like to request leave under the The Families First Coronavirus Response Act (FFCRA or Act), please submit the below form:

This is the first date you will not be working due to the FFCRA need.

This is the date you expect to return to work after the FFCRA need.

 
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