Employee Opt-Out Of Paid Family Leave Benefits Form - Oct 2017

The form is used by employees who wish to waive their right to Paid Family Leave in New York State. By completing it, employees indicate they do not want to participate in the Paid Family Leave program and will not be eligible for benefits. The form collects employee information and must be submitted to the employer for processing.

Employees who wish to waive their right to Paid Family Leave.

The completed Employee Opt-Out Of Paid Family Leave Benefits Form should be submitted to the Employer.