471-070-1100 Benefits: Application for Benefits (1) To request Paid Leave Oregon benefits provided under the state plan established in ORS 657B.340, a claimant must submit an application for benefits. An application must be submitted online or by another method approved by the department. For the application to be approved by the department, the application must be complete and must include, but is not limited to, the following: (a) Claimant information, including: (A) First and last name; (B) Date of birth; (C) Social Security Number or Individual Taxpayer Identification Number; and (D) Contact information, including mailing address and telephone number. (b) Documentation sufficient to establish the claimant’s identity; (c) Information about the claimant’s current employment or self-employment for which they are requesting leave from work: (A) Business name(s) and dates of employment or self-employment; (B) Business address and contact information for all employers or self-employed businesses; (C) Average number of work days worked per work week; and (D) Any current breaks from work or anticipated future breaks from work that are unrelated to Paid Leave Oregon leave. (d) Information about the notice given to any employers under ORS 657B.040 and OAR 471-070-1310, if applicable, and the date(s) any notice was given; (e) Information about the claimant’s leave schedule, including: (A) Employer(s) from which leave is being taken; (B) Anticipated leave dates; and (C) Whether the leave is to be taken in consecutive or intermittent periods. (f) The type of leave taken by the claimant, which must be one of the following: (A) Family leave; (B) Medical leave; or (C) Safe leave. (g) Verification of the reason for the leave, including: (A) For family leave to care for or bond with a child, verification consistent with OAR 471-070-1110; (B) For family leave for pre-placement leave, verification consistent with OAR 471-070-1115; (C) For family leave to care for a family member with a serious health condition, verification consistent with OAR 471-070-1120 and an attestation that the claimant has a relationship equal to “family member” under ORS 657B.010 and is caring for a family member with a serious health condition; (D) For medical leave, verification consistent with OAR 471-070-1120; or (E) For safe leave, verification consistent with OAR 471-070-1130. (h) If the claimant is requesting up to two additional weeks of leave for limitations related to pregnancy, childbirth or a related medical condition, documentation that the claimant is currently pregnant or was pregnant within the year prior to the start of the additional two weeks of leave; (i) Information about the claimant’s eligibility to receive workers’ compensation time loss benefits under ORS chapter 656 or Unemployment Insurance benefits under ORS chapter 657; and (j) A written or electronically signed statement declaring under oath that the information provided in support of the application for Paid Leave Oregon benefits is true and correct to the best of the individual’s knowledge. (2) An employee who has Paid Leave Oregon coverage solely through an employer with an equivalent plan approved under ORS 657B.210 must apply for Paid Family and Medical Leave Insurance benefits by following the employer’s equivalent plan application guidelines. (3) An employee who is simultaneously covered by more than one employer’s equivalent plan approved under ORS 657B.210, or that is simultaneously covered by the state plan and at least one employer with an equivalent plan, must apply separately under all plans they are covered under and from which they are taking leave by following the respective application guidelines for each plan. (4) A complete application for Paid Leave Oregon may be submitted to the department up to 30 calendar days prior to the start of family, medical, or safe leave and up to 30 calendar days after the start of leave. Applications submitted outside of this timeframe, either early or late, will be denied, except in cases where a claimant can demonstrate an application was submitted late for reasons that constitute good cause under section (5) of this rule. (5) Good cause exists when a claimant establishes by satisfactory evidence submitted to the department that factors or circumstances beyond the claimant’s control prevented the claimant from submitting a completed application within the required timeframe under section (4) of this rule. Good cause for the late submission of an application is determined at the discretion of the department and includes, but is not limited to, the following: (a) A serious health condition that results in an unanticipated and prolonged period of incapacity and that prevents an individual from timely filing an application; or (b) A demonstrated inability to reasonably access a means to file an application in a timely manner, such as an inability to file an application due to a natural disaster or a significant and prolonged department system outage. (6) If the department determines the claimant demonstrated good cause for late submission of an application, the department may accept the application up to one year after the start of leave. [Publications: Contact the Oregon Employment Department for information about how to obtain a copy of the publication referred to or incorporated by reference in this rule.] Statutory/Other Authority: ORS 657B.090, 657B.100 & 657B.340 Statutes/Other Implemented: ORS 657B.090, 657B.100 & Chapter 20 Oregon Laws 2024 History: ED 73-2025, minor correction filed 03/28/2025, effective 03/28/2025 ED 6-2024, amend filed 12/27/2024, effective 01/01/2025 ED 5-2024, amend filed 07/30/2024, effective 08/01/2024 ED 5-2023, amend filed 07/31/2023, effective 08/01/2023 ED 9-2022, adopt filed 07/22/2022, effective 07/22/2022