HRW COVID-19 Resources: FFCRA Request for Leave Form

By Catherine Reuben, Charlotte Petilla, Peter Moser, Ari Kristan, Richard Loftus, Liz Monnin-Browder, David Wilson   April 3, 2020

The Hirsch Roberts Weinstein Team recognizes that the COVID-19 emergency is challenging employers in unprecedented ways. In order to assist employers facing these challenges, HRW will from time to time publish COVID-19 Resources. These COVID-19 Resources are not legal advice. HRW encourages you to reach out to your firm contact or any of the attorneys listed below with questions or concerns about any COVID-19 related issues.

Many businesses with under 500 employees are now subject to the Families First Coronavirus Response Act (FFCRA). To help employers comply with the new law, HRW has developed this FFCRA Request for Leave Form, which incorporates the documentation requirements set forth in Frequently Asked Questions maintained by the IRS and the Department of Labor Temporary Rule released on April 1, 2020.

This form is NOT legal advice. The FFCRA is a new law, with new agency interpretations being issued almost daily, and with many unanswered questions still remaining. We provide this form as a reference tool for employers to consider. Note also that the Department of Labor and/or Department of the Treasury may soon issue its own form, or further guidance for employers on what information and documentation to seek. We provide this form as a temporary tool for employers to use.

Click here to download/view our FFCRA Request for Leave Form.

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