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Request for Leave Under the Families First Coronavirus Response Act (FFCRA) Form

Author: Steven J. Luckner, Ogletree Deakins

When to Use

An employer that voluntarily continues to offer leave under the Families First Coronavirus Response Act (FFCRA) framework from January 1, 2021, through September 30, 2021 may ask employees to fill out this form when they request leave that may qualify as emergency paid sick leave or expanded family and medical leave under the law. The specific information needed from the employee may vary based on the reason for leave.

Written documentation of an employee's leave request will help substantiate an employer's eligibility for the FFCRA's paid leave tax credit. This form can be used to document this information.

Customizable Form