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Stephanie Haber
/ Categories: Claims, Client Information, Q&A

Top 3 Must See - Q&A on Paid Family Leave Forms

January 30, 2018

PFL Forms

While Paid Family Leave is intended to make your lives a little easier by providing paid time off for life events, there are a lot of questions that pop up. We’re going to answer those questions for you in our new monthly series, “Top 3 Must See”. These are all real questions, sent to us from brokers, employers, and employees like you.

In our first installment, we’re going to answer a few questions about Forms.


1. Will the claim forms be customized with ShelterPoint’s contact information, so the employee knows where to send the forms?


In a way, yes. We have claim forms available for download on our website (you can find them here). There are two types of claim form packets available for each type of qualifying leave: The generic forms provided by NY State, and a ShelterPoint-specific form. These ShelterPoint-specific versions are the NY State forms but ShelterPoint’s mailing address is prefilled in the insurance carrier section.  If you’re a ShelterPoint policyholder you can use these “custom” claim forms.

It might be helpful (for you and your employees), to add ShelterPoint’s (or whoever your PFL insurance carrier is) contact information in the same places you post your PFL information. You can use this great resource from NY State to get started — there’s even a place where you can add your company’s contact for all things PFL, as well as ShelterPoint’s contact information. This way there may be fewer questions about where to send the forms when your employees apply for benefits.


2. How do I know which form/s I need to file for my claim?

We’ve put together an easy chart to explain what forms you need, and who you need to fill out those forms, depending on the type of leave taken.

PFL Claim Type

PFL-1 form
Request for Paid Family Leave

PFL-2 form
Bonding certification

PFL-3 form
Release of personal health information

PFL-4 form
Certification of care

PFL-5 form
Military qualifying event certification

Supporting Documentation


Part A: completed by you


Part B:
Completed by your employer. (They must complete their section & return to you within 3 business days)

Completed by you




Proving your relationship with the child.  Ex. Birth certificate



Completed by the “Care recipient” (the family member you’re providing care for)*

Completed by you & the heath care provider treating your family member



Military Exigency




Completed by you & any applicable third party

Documents evidencing military members status and the need for leave


*This is filed with their health care provider, so the provider can fill out the PFL-4 form. Do not file PFL-3 form with your insurance carrier.

You can also check out this post where you can download visual claim roadmaps for each type of leave.


3. When is the PFL Posting Notice (DB-120) available online to print, or is one being mailed out?

If you’re a ShelterPoint Policyholder your DB-120 notices are available here to download and print.  If you aren’t with ShelterPoint, you’ll need to reach out to your insurance carrier for a copy. 

It’s important (and required by PFL law) to make sure you have materials available for your employees so they are aware of Paid Family Leave and what to do if they decide to take it. New York State released some helpful language that you can easily model for your employee handbook, or for a poster to hang up in your breakroom. You can check out that information here.


Have questions about forms, or other Paid Family Leave topics? Check back soon to see if we cover your question in our next installment, or ask our PFL experts at pflquestions@shelterpoint.com.


This blog post is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice. Any PFL information is as of the blog post’s date stamp; it is based on the applicable statutes and regulation,  and may change as regulations evolve or NY State issues guidance regarding Paid Family Leave regulations. Have more questions? Email us at pflquestions@shelterpoint.com

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