New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter H - Disability Benefits › Article 2 - Rules Under Disability Benefits Law › Part 380 - Paid Family Leave › Subpart 380-4 - Request for Paid Family Leave, Medical Certification and HIPAA Authorization › Section 380-4.3 - Certification for leave taken because of a qualifying military exigency

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Active
						duty orders.
The first time an employee requests leave because of a
						  qualifying exigency arising out of the covered active duty or call to covered
						  active duty status (or notification of an impending call or order to covered
						  active duty) of a military member, a carrier or self-insured employer may
						  require the employee to provide a copy of the military member's active duty
						  orders or other documentation issued by the military which indicates that the
						  military member is on covered active duty or call to covered active duty
						  status, and the dates of the military member's covered active duty service.
						  This information need only be provided to the carrier or self-insured employer
						  once. A copy of new active duty orders or other documentation issued by the
						  military may be required by the carrier or self-insured employer if the need
						  for leave because of a qualifying exigency arises out of a different covered
						  active duty or call to covered active duty status (or notification of an
						  impending call or order to covered active duty) of the same or a different
						  military member.
(b)
Required information.
A request for paid family leave for any qualifying
						  exigency specified in section
						  380-2.3 
						  of this Part must be supported by a certification from the employee that sets
						  forth the following information:
(1)
						statement or description, signed by the employee, of appropriate facts
						regarding the qualifying exigency for which paid family leave is requested. The
						facts must be sufficient to support the need for leave. Such facts include
						information on the type of qualifying exigency for which leave is requested and
						any available written documentation which supports the request for leave; such
						documentation, for example, may include a copy of a meeting announcement for
						informational briefings sponsored by the military, a document confirming an
						appointment with a counselor or school official, or a copy of a bill for
						services for the handling of legal or financial affairs;
(2) approximate date on which the qualifying
						exigency commenced or will commence;
(3) if an employee requests leave because of
						a qualifying exigency for a single, continuous period of time, the beginning
						and end dates for such absence;
(4)
						if an employee requests leave because of a qualifying exigency on an
						intermittent basis, an estimate of the frequency and duration of the qualifying
						exigency;
(5) if the qualifying
						exigency involves meeting with a third party, appropriate contact information
						for the individual or entity with whom the employee is meeting (such as the
						name, title, organization, address, telephone number, fax number, and email
						address [if available]) and a brief description of the purpose of the meeting;
						and
(6) if the qualifying exigency
						involves rest and recuperation leave, a copy of the military member's rest and
						recuperation orders, or other documentation issued by the military which
						indicates that the military member has been granted rest and recuperation
						leave, and the dates of the military member's rest and recuperation
						leave.