敝�s��XtG�ec��;������x�=OF������0�Ϟ�f&p!�7C���ᗫ��� ���E�'���Ȏt�PWF]PN����)E�i�Y+� a�4"I�80�F����J*�ج��"����S+"��377p |5[U�F�D:C�l��A#66T��l!$9��-��(?A�n��ߠB�l����� ��S>Koפ[�蚘0��J�&`8��E�4�ǯ@�]}��P��.�w�E�P$'�k��K�U�~'����n�t^�R��au�j��h��%p�hظ�����N�(L�|13|^N �~oz��.��2��Dv�i�"gJ�G1�smGi���9JNJReA鑂�"��U�ny?y����.|׏� ���-�7"l�[͉:F�h�,_�5G/qN�M�O�d��X��YiK�x��Wk�*�$���,y��f���O�|�$��FyӮ=�[���ŀ�v5�M�~DR�4��TM���Y��z�4C�pT:%�>�,�� �>l-8$�kz�-W�E^�ivW�P֙�r�Z. is subject to a Federal, State, or local quarantine or isolation order related to COVID-19; has been advised by a health care provider to self-quarantine related to COVID-19; is experiencing COVID-19 symptoms and is seeking a medical diagnosis; is caring for an individual subject to an order described in (1) or self-quarantine as described in (2); is caring for a child whose school or place of care is closed (or child care provider is unavailable) for reasons related to COVID-19; or. The Families First Coronavirus Response Act provides tax credits to reimburse employers for the costs of providing paid sick leave and paid family and medical leave to employees unable to work because of the coronavirus (COVID-19). 4 0 obj 2 0 obj The Families First Coronavirus (COVID-19) Response Act allows full-time workers (40 hours or more per week) to get 80 hours of paid leave, and part-time workers get the average number of hours they work in a 2-week pay period. Section II. However, federal employees covered by Title II of the Family and Medical Leave Act are covered by the paid sick leave provision. @media only screen and (min-width: 0px){.agency-nav-container.nav-is-open {overflow-y: unset!important;}} EMERGENCY PAID SICK LEAVE REQUESTED – REASONS 1, 2 OR 3 Select one of the options listed below if you are unable to work or telework 1. [4]. 3 0 obj [4] An employee may elect to substitute any accrued vacation leave, personal leave, or medical or sick leave for the first two weeks of partial paid leave under this section. .dol-alert-status-error .alert-status-container {display:inline;font-size:1.4em;color:#e31c3d;} .usa-footer .grid-container {padding-left: 30px!important;} See Department FFCRA regulations (expected April 2020). However, employees must exhaust COVID-19 Leave Under the FFCRA, an employee qualifies for paid sick time if the employee is unable to work (or unable to telework) due to a need for leave because the employee: Under the FFCRA, an employee qualifies for expanded family leave if the employee is caring for a child whose school or place of care is closed (or child care provider is unavailable) for reasons related to COVID-19. EMPLOYEE REQUEST FOR EMERGENCY PAID SICK LEAVE OR EMERGENCY FAMILY AND MEDICAL LEAVE FOR COVID-19 (CORONAVIRUS) RELATED REASON AND SELF CERTIFICATION . These credits are refundable. The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. LEAVE REQUEST FORM . To request emergency paid sick leave under the Families First Coronavirus Response Act (FFCRA) and the County’sEmergency Paid Sick Leave and Emergency Family Medical Leave Expansion Policy Related to COVID-19, you must complete this request form and submit it to the Human Resources Department as soon as possible. The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide their employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. #block-googletagmanagerheader .field { padding-bottom:0 !important; } 6201), which was signed into law on March 18, will provide paid emergency family leave … For leave reason (5): employees taking leave are entitled to pay at 2/3 their regular rate or 2/3 the applicable minimum wage, whichever is higher, up to $200 per day and $12,000 in the aggregate (over a 12-week period). EMERGENCY PAID SICK LEAVE REQUEST FORM FOR COVID-19-RELATED LEAVE. <> COVID-19 Emergency Paid Sick Leave Certification Statement This form should be completed by the employee and submitted to the _____. Federal government websites often end in .gov or .mil. .manual-search ul.usa-list li {max-width:100%;} On April 1, 2020, the U.S. Department of Labor announced new action regarding how American workers and employers will benefit from the protections and relief offered by the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, both part of the Families First Coronavirus Response Act (FFCRA). .manual-search-block #edit-actions--2 {order:2;} National Paid Leave FMLA: Your employee is taking leave under the Family Medical Leave Act (FMLA) to care for children under 18 whose school or child care is closed because of COVID-19. <> 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. .cd-main-content p, blockquote {margin-bottom:1em;} A list of the required documents is provided at the end of this application. For reason (5): A full-time employee is eligible for up to 12 weeks of leave (two weeks of paid sick leave followed by up to 10 weeks of paid expanded family & medical leave) at 40 hours a week, and a part-time employee is eligible for leave for the number of hours that the employee is normally scheduled to work over that period. The Families First Coronavirus Response Act (the "FFCRA"), signed by President Trump on March 18, 2020, provides small and midsize employers refundable tax credits that reimburse them, dollar-for-dollar, for the cost of providing paid sick and family leave wages to their employees for leave related to COVID-19. .usa-footer .container {max-width:1440px!important;} ol{list-style-type: decimal;} COVID-19 Paid Sick Leave. 1-866-4-US-WAGE National Paid Leave Family: Your employee is taking care of a family member who is sick or impacted with COVID-19. 1-866-487-9243, Administrator Interpretations, Opinion and Ruling Letters, Resources for State and Local Governments, Families First Coronavirus Response Act: Employee Paid Leave Rights, Severe Storm and Flood Recovery Assistance. Protecting All New Yorkers During Uncertain Times. #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} 1 . Benefits may apply to those who are sick, caring for others who are sick, or caring for children out of school or daycare due to COVID-19. endobj [1] Certain provisions may not apply to certain employers with fewer than 50 employees. Advised by healthcare provider to self-quarantine related to COVID-19 The California COVID-19 Supplemental Paid Sick Leave law is clear that the obligation to provide COVID-19 Supplemental Paid Sick Leave is in addition to regular paid sick leave. This relief helps ensure employees are not forced to choose between being paid or staying home to care for themselves, a child or other family member. [1] Most employees of the federal government are covered by Title II of the Family and Medical Leave Act, which was not amended by this Act, and are therefore not covered by the expanded family and medical leave provisions of the FFCRA. An official website of the United States government. An agency within the U.S. Department of Labor, 200 Constitution Ave NW After the first workday of paid sick time, an employer may require employees to follow reasonable notice procedures in order to continue receiving paid sick time. Employees have new rights, and employers have significant new responsibilities under Washington's Paid Sick Leave law, which was … 116-127 (Notice 2020-54).The Families First Act, enacted March 18, requires employers with fewer than 500 employees to provide paid sick leave or family or medical leave for their employees who miss work … Employee Name (print clearly) Date. COVID Tax Tip 2020-63 , May 28, 2020 Under the Families First Coronavirus Response Act, employers can grant paid leave for an employee to take care of their health needs related to COVID -19 or to care for their family members. These provisions apply to leave taken between April 1, 2020 and December 31, 2020. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} .table thead th {background-color:#f1f1f1;color:#222;} [3] Paid sick time provided under this Act does not carryover from one year to the next. Eligible Employees: All employees of covered employers are eligible for two weeks of paid sick time for specified reasons related to COVID-19. Employees are not entitled to reimbursement for unused leave upon termination, resignation, retirement, or other separation from employment. %���� 1 0 obj Paid sick leave up to two weeks or 80 hours at 2/3 of the employee’s regular rate or the minimum wage (whichever is higher),* if either scenario applies: You’re caring for somebody under quarantine or a stay-at-home order. Notice: Where leave is foreseeable, an employee should provide notice of leave to the employer as is practicable. Employees employed for at least 30 days are eligible for up to an additional 10 weeks of paid family leave to care for a child under certain circumstances related to COVID-19.[2]. .homepage-news-block > .news-button {display:none;} This web page provides information and guidance on the state's paid sick leave laws in connection with the coronavirus (COVID-19) outbreak. Employers receive 100% reimbursement for paid leave pursuant to the Act. Health Care Employee Pandemic Paid Sick Leave. … Supervisor: I am unable to work, including engaging in telework and would like to request emergency paid sick leave because #block-googletagmanagerfooter .field { padding-bottom:0 !important; } The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. endobj .h1 {font-family:'Merriweather';font-weight:700;} Must an employer grant leave to an employee who is sick or who is caring for a family member that … These provisions will apply from the effective date through December 31, 2020. <>/Metadata 128 0 R/ViewerPreferences 129 0 R>> On April 1, 2020, employers with less than 500 employees will be subject to the provisions of the Families First Coronavirus Response Ac t (the Act), which includes the Emergency Paid Sick Leave Act and the Emergency Family and Medical Leave Expansion Act (FMLA). /*-->*/. p.usa-alert__text {margin-bottom:0!important;} #block-opa-theme-content > div > div.guidance-search > div.csv-feed.views-data-export-feed {display:none;} Generally, the Act provides that employees of covered employers are eligible for: Covered Employers: The paid sick leave and expanded family and medical leave provisions of the FFCRA apply to certain public employers, and private employers with fewer than 500 employees. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Paid Sick Leave (up to 10 days) – employees are eligible for up to two … This page has information and guidance on use of the state's paid sick leave laws (RCW 49.46 and WAC 296-128) in connection with the recent coronavirus (COVID-19) outbreak.L&I encourages employers to provide flexible paid sick leave policies that are consistent with state and local public health guidance and laws, and to make employees aware of those policies. On March 18, 2020, Governor Cuomo signed emergency legislation guaranteeing job protection and pay for New Yorkers who have been quarantined as a result of novel coronavirus, or COVID-19. The site is secure. Form PFL-271S (2021) - Statement of Rights for Paid Family Leave Learn more about PFL-271S Form (2021) COVID-19, Employee Employees who wish to continue to accrue vacation or sick leave must use the applicable leave (e.g., sick, vacation, or compensatory time) under their collective bargaining agreement or compensation plan, rather than Paid COVID-19 Leave. For leave reasons (1), (2), or (3): employees taking leave are entitled to pay at either their regular rate or the applicable minimum wage, whichever is higher, up to $511 per day and $5,110 in the aggregate (over a 2-week period). Before you begin your application, to the extent possible, please ensure that you have the required supporting documents completed and readily available for submission. EMERGENCY PAID SICK LEAVE REQUEST FORM FOR COVID-19-RELATED LEAVE Effective for requests made on or after April 1, 2020 through December 31, 2020. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The Department of Labor (DOL) issued guidance in the form of Questions and Answers to clarify employer obligations … Before sharing sensitive information, make sure you’re on a federal government site. stream Reason for Leave I am requesting time off work for the following reason(s) (check all that apply): Paid Sick Leave: A full-time employee is eligible for 80 hours of leave, and a part-time employee is eligible for the Employees requesting either Emergency Paid Sick Leave or Emergency Family and Medical Leave must complete this form, collect The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. : Employee paid leave pursuant to the Act, special rules apply for Care. 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coronavirus paid sick leave form

The .gov means it’s official. The Families First Coronavirus Response Act (FFCRA) gives paid leave to many employees who are impacted by COVID-19. [CDATA[/* >敝�s��XtG�ec��;������x�=OF������0�Ϟ�f&p!�7C���ᗫ��� ���E�'���Ȏt�PWF]PN����)E�i�Y+� a�4"I�80�F����J*�ج��"����S+"��377p |5[U�F�D:C�l��A#66T��l!$9��-��(?A�n��ߠB�l����� ��S>Koפ[�蚘0��J�&`8��E�4�ǯ@�]}��P��.�w�E�P$'�k��K�U�~'����n�t^�R��au�j��h��%p�hظ�����N�(L�|13|^N �~oz��.��2��Dv�i�"gJ�G1�smGi���9JNJReA鑂�"��U�ny?y����.|׏� ���-�7"l�[͉:F�h�,_�5G/qN�M�O�d��X��YiK�x��Wk�*�$���,y��f���O�|�$��FyӮ=�[���ŀ�v5�M�~DR�4��TM���Y��z�4C�pT:%�>�,�� �>l-8$�kz�-W�E^�ivW�P֙�r�Z. is subject to a Federal, State, or local quarantine or isolation order related to COVID-19; has been advised by a health care provider to self-quarantine related to COVID-19; is experiencing COVID-19 symptoms and is seeking a medical diagnosis; is caring for an individual subject to an order described in (1) or self-quarantine as described in (2); is caring for a child whose school or place of care is closed (or child care provider is unavailable) for reasons related to COVID-19; or. The Families First Coronavirus Response Act provides tax credits to reimburse employers for the costs of providing paid sick leave and paid family and medical leave to employees unable to work because of the coronavirus (COVID-19). 4 0 obj 2 0 obj The Families First Coronavirus (COVID-19) Response Act allows full-time workers (40 hours or more per week) to get 80 hours of paid leave, and part-time workers get the average number of hours they work in a 2-week pay period. Section II. However, federal employees covered by Title II of the Family and Medical Leave Act are covered by the paid sick leave provision. @media only screen and (min-width: 0px){.agency-nav-container.nav-is-open {overflow-y: unset!important;}} EMERGENCY PAID SICK LEAVE REQUESTED – REASONS 1, 2 OR 3 Select one of the options listed below if you are unable to work or telework 1. [4]. 3 0 obj [4] An employee may elect to substitute any accrued vacation leave, personal leave, or medical or sick leave for the first two weeks of partial paid leave under this section. .dol-alert-status-error .alert-status-container {display:inline;font-size:1.4em;color:#e31c3d;} .usa-footer .grid-container {padding-left: 30px!important;} See Department FFCRA regulations (expected April 2020). However, employees must exhaust COVID-19 Leave Under the FFCRA, an employee qualifies for paid sick time if the employee is unable to work (or unable to telework) due to a need for leave because the employee: Under the FFCRA, an employee qualifies for expanded family leave if the employee is caring for a child whose school or place of care is closed (or child care provider is unavailable) for reasons related to COVID-19. EMPLOYEE REQUEST FOR EMERGENCY PAID SICK LEAVE OR EMERGENCY FAMILY AND MEDICAL LEAVE FOR COVID-19 (CORONAVIRUS) RELATED REASON AND SELF CERTIFICATION . These credits are refundable. The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. LEAVE REQUEST FORM . To request emergency paid sick leave under the Families First Coronavirus Response Act (FFCRA) and the County’sEmergency Paid Sick Leave and Emergency Family Medical Leave Expansion Policy Related to COVID-19, you must complete this request form and submit it to the Human Resources Department as soon as possible. The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide their employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. #block-googletagmanagerheader .field { padding-bottom:0 !important; } 6201), which was signed into law on March 18, will provide paid emergency family leave … For leave reason (5): employees taking leave are entitled to pay at 2/3 their regular rate or 2/3 the applicable minimum wage, whichever is higher, up to $200 per day and $12,000 in the aggregate (over a 12-week period). EMERGENCY PAID SICK LEAVE REQUEST FORM FOR COVID-19-RELATED LEAVE. <> COVID-19 Emergency Paid Sick Leave Certification Statement This form should be completed by the employee and submitted to the _____. Federal government websites often end in .gov or .mil. .manual-search ul.usa-list li {max-width:100%;} On April 1, 2020, the U.S. Department of Labor announced new action regarding how American workers and employers will benefit from the protections and relief offered by the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, both part of the Families First Coronavirus Response Act (FFCRA). .manual-search-block #edit-actions--2 {order:2;} National Paid Leave FMLA: Your employee is taking leave under the Family Medical Leave Act (FMLA) to care for children under 18 whose school or child care is closed because of COVID-19. <> 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. .cd-main-content p, blockquote {margin-bottom:1em;} A list of the required documents is provided at the end of this application. For reason (5): A full-time employee is eligible for up to 12 weeks of leave (two weeks of paid sick leave followed by up to 10 weeks of paid expanded family & medical leave) at 40 hours a week, and a part-time employee is eligible for leave for the number of hours that the employee is normally scheduled to work over that period. The Families First Coronavirus Response Act (the "FFCRA"), signed by President Trump on March 18, 2020, provides small and midsize employers refundable tax credits that reimburse them, dollar-for-dollar, for the cost of providing paid sick and family leave wages to their employees for leave related to COVID-19. .usa-footer .container {max-width:1440px!important;} ol{list-style-type: decimal;} COVID-19 Paid Sick Leave. 1-866-4-US-WAGE National Paid Leave Family: Your employee is taking care of a family member who is sick or impacted with COVID-19. 1-866-487-9243, Administrator Interpretations, Opinion and Ruling Letters, Resources for State and Local Governments, Families First Coronavirus Response Act: Employee Paid Leave Rights, Severe Storm and Flood Recovery Assistance. Protecting All New Yorkers During Uncertain Times. #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} 1 . Benefits may apply to those who are sick, caring for others who are sick, or caring for children out of school or daycare due to COVID-19. endobj [1] Certain provisions may not apply to certain employers with fewer than 50 employees. Advised by healthcare provider to self-quarantine related to COVID-19 The California COVID-19 Supplemental Paid Sick Leave law is clear that the obligation to provide COVID-19 Supplemental Paid Sick Leave is in addition to regular paid sick leave. This relief helps ensure employees are not forced to choose between being paid or staying home to care for themselves, a child or other family member. [1] Most employees of the federal government are covered by Title II of the Family and Medical Leave Act, which was not amended by this Act, and are therefore not covered by the expanded family and medical leave provisions of the FFCRA. An official website of the United States government. An agency within the U.S. Department of Labor, 200 Constitution Ave NW After the first workday of paid sick time, an employer may require employees to follow reasonable notice procedures in order to continue receiving paid sick time. Employees have new rights, and employers have significant new responsibilities under Washington's Paid Sick Leave law, which was … 116-127 (Notice 2020-54).The Families First Act, enacted March 18, requires employers with fewer than 500 employees to provide paid sick leave or family or medical leave for their employees who miss work … Employee Name (print clearly) Date. COVID Tax Tip 2020-63 , May 28, 2020 Under the Families First Coronavirus Response Act, employers can grant paid leave for an employee to take care of their health needs related to COVID -19 or to care for their family members. These provisions apply to leave taken between April 1, 2020 and December 31, 2020. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} .table thead th {background-color:#f1f1f1;color:#222;} [3] Paid sick time provided under this Act does not carryover from one year to the next. Eligible Employees: All employees of covered employers are eligible for two weeks of paid sick time for specified reasons related to COVID-19. Employees are not entitled to reimbursement for unused leave upon termination, resignation, retirement, or other separation from employment. %���� 1 0 obj Paid sick leave up to two weeks or 80 hours at 2/3 of the employee’s regular rate or the minimum wage (whichever is higher),* if either scenario applies: You’re caring for somebody under quarantine or a stay-at-home order. Notice: Where leave is foreseeable, an employee should provide notice of leave to the employer as is practicable. Employees employed for at least 30 days are eligible for up to an additional 10 weeks of paid family leave to care for a child under certain circumstances related to COVID-19.[2]. .homepage-news-block > .news-button {display:none;} This web page provides information and guidance on the state's paid sick leave laws in connection with the coronavirus (COVID-19) outbreak. Employers receive 100% reimbursement for paid leave pursuant to the Act. Health Care Employee Pandemic Paid Sick Leave. … Supervisor: I am unable to work, including engaging in telework and would like to request emergency paid sick leave because #block-googletagmanagerfooter .field { padding-bottom:0 !important; } The Department of Labor’s (Department) Wage and Hour Division (WHD) administers and enforces the new law’s paid leave requirements. endobj .h1 {font-family:'Merriweather';font-weight:700;} Must an employer grant leave to an employee who is sick or who is caring for a family member that … These provisions will apply from the effective date through December 31, 2020. <>/Metadata 128 0 R/ViewerPreferences 129 0 R>> On April 1, 2020, employers with less than 500 employees will be subject to the provisions of the Families First Coronavirus Response Ac t (the Act), which includes the Emergency Paid Sick Leave Act and the Emergency Family and Medical Leave Expansion Act (FMLA). /*-->*/. p.usa-alert__text {margin-bottom:0!important;} #block-opa-theme-content > div > div.guidance-search > div.csv-feed.views-data-export-feed {display:none;} Generally, the Act provides that employees of covered employers are eligible for: Covered Employers: The paid sick leave and expanded family and medical leave provisions of the FFCRA apply to certain public employers, and private employers with fewer than 500 employees. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Paid Sick Leave (up to 10 days) – employees are eligible for up to two … This page has information and guidance on use of the state's paid sick leave laws (RCW 49.46 and WAC 296-128) in connection with the recent coronavirus (COVID-19) outbreak.L&I encourages employers to provide flexible paid sick leave policies that are consistent with state and local public health guidance and laws, and to make employees aware of those policies. On March 18, 2020, Governor Cuomo signed emergency legislation guaranteeing job protection and pay for New Yorkers who have been quarantined as a result of novel coronavirus, or COVID-19. The site is secure. Form PFL-271S (2021) - Statement of Rights for Paid Family Leave Learn more about PFL-271S Form (2021) COVID-19, Employee Employees who wish to continue to accrue vacation or sick leave must use the applicable leave (e.g., sick, vacation, or compensatory time) under their collective bargaining agreement or compensation plan, rather than Paid COVID-19 Leave. For leave reasons (1), (2), or (3): employees taking leave are entitled to pay at either their regular rate or the applicable minimum wage, whichever is higher, up to $511 per day and $5,110 in the aggregate (over a 2-week period). Before you begin your application, to the extent possible, please ensure that you have the required supporting documents completed and readily available for submission. EMERGENCY PAID SICK LEAVE REQUEST FORM FOR COVID-19-RELATED LEAVE Effective for requests made on or after April 1, 2020 through December 31, 2020. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The Department of Labor (DOL) issued guidance in the form of Questions and Answers to clarify employer obligations … Before sharing sensitive information, make sure you’re on a federal government site. stream Reason for Leave I am requesting time off work for the following reason(s) (check all that apply): Paid Sick Leave: A full-time employee is eligible for 80 hours of leave, and a part-time employee is eligible for the Employees requesting either Emergency Paid Sick Leave or Emergency Family and Medical Leave must complete this form, collect The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. : Employee paid leave pursuant to the Act, special rules apply for Care. 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