Form to request FFCRA Emergency Expanded FMLA (COVID-19) - EXPIRED
If you are unable to work due to a bona fide need for leave to care for a child whose school or child care provider is closed or unavailable for reasons related to COVID-19 the FFCRA Emergency Expanded FMLA (COVID-19) provides up to an additional 10 weeks of paid expanded family and medical leave at two-thirds the employee’s regular rate of pay for an employee has been employed for at least 30 calendar days.
The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. These provisions will apply from the effective date through December 31, 2020. More information available about FFCRA is at https://www.dol.gov/agencies/whd/pandemic/ffcra-employee-paid-leave
Submission Instructions for a block of time off for childcare/school closure:
- Fill out the Form to Request FFCRA Emergency Expanded FMLA for a block of time off (COVID-19) completely, sign, and provide a copy of it to your Manager.
- Upload the completed copy to Workday Leave of Absence Request for COVID-19 Leave for School/Childcare Closure.
Submission Instructions for intermittent time off for childcare/school closure:
- Please return the completed Form to Request FFCRA Emergency Expanded FMLA for Intermittent Leave (COVID-19) with additional supporting documentation, as noted, to your supervisor.
- Your supervisor will review your request and send it to the Human Resources Department for processing.