Do not wait to request Paid Family Leave (PFL) benefits. Californians can make sure the income stays steady during the time taken off work to care for a family member or bond with a new child by immediately making a claim for benefits.

The longer a worker waits, the longer the time they will live and care for someone without an income.

1. Decide the date the benefits will begin. The worker that gets the benefits has the choice of when to start. The start date is used to decide the weekly benefit amount. A total six weeks of benefits are available.

2. Fill out and sign the Statement of Claimant on the Claim for Paid Family Leave (PFL) Benefits form. This main part of the form is where the name and contact information for both the claimant and the employer is written. The staff at the Employment Development Department (EDD) also uses this part to see that all the dates fit together--date last worked, a chosen date for benefits to start, and the return to work date.

State the reason for the paid leave request-- to take care of a family member, bond with a new child, or other reason.

Forms are available online at the Employment Development Department's website for disability. Or, call or visit a Disability Office.

3. Have a person receiving care authorize disclosure of personal health information and make a signed statement. The person supports the doctors diagnosis and prognosis and their estimate of the amount of care needed. An authorization statement is read and signed. Then, the person fills out and signs a statement on the claim form.

4. If bonding with a new child, certify the bonding. On the form, identify the child by name and social security number and tell the office the child's relationship. State the date for the birth or the adoption or foster care. Sign.

5. If taking leave to care for a family member, have the doctor certify the health condition of the person receiving care and their need for care. The last part of the claim is the doctor's certification. The doctor gives their diagnosis and confirms a couple of dates, the date the family member's health condition began and the date a recovery is expected.

They also give their professional diagnosis on how long the condition will last and a timetable for care. The first care day is stated and the last day the patient will need care. An estimate for the number of hours the family member will need care each day is written with comments.

M.D.s and D.O.s are qualified for making the certification. So are chiropractors, dentists, optometrists, podiatrists, psychologists, nurse midwives, licensed midwives, and nurse practitioners.

There are several other persons that can fill out and sign the certification. An accredited religious practitioner is one of them. Workers can also use the registrar at the county hospital, the medical officer at a U. S. government medical facility, or a state or local health officer.

Tip

Pregnant women receiving disability insurance benefits do not have to request a Paid Family Leave claim form for bonding with a new child. The form is sent to them when the disability claim ends.

NOTE. If the claimant is unable to fill out the form because of a physical or mental health condition, or the person filling out the form is an agent for the worker, call the EDD disability office and request a different claim form.

Source:

California, Employment Development Department, Sample Claim for Paid Family Leave (PFL) Benefits.