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Application for Emergency Paid Sick Leave or Expanded FMLA Through The Families First Coronavirus Response Act (FF CRA) (eff. 412020/exp. 12312020) (Please Print)Employee Name:Date:Department:Phone

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How to fill out determining your ffcra eligibility

01

Gather information on whether you are an employee or an independent contractor

02

Determine if your employer has fewer than 500 employees

03

Check if you are seeking leave due to a COVID-19 related reason

04

Fill out the FFCRA eligibility form accurately and truthfully

Who needs determining your ffcra eligibility?

01

Employees who are seeking leave due to COVID-19 related reasons

02

Employers with fewer than 500 employees

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What is determining your ffcra eligibility?

The determination of FFCRA eligibility is based on specific criteria outlined in the Families First Coronavirus Response Act.

Who is required to file determining your ffcra eligibility?

Employees who believe they are eligible for FFCRA benefits are required to submit the necessary information to their employer for review and approval.

How to fill out determining your ffcra eligibility?

To fill out the FFCRA eligibility determination form, employees must provide details about their qualifying reason for leave, the duration of leave needed, and any supporting documentation as required.

What is the purpose of determining your ffcra eligibility?

The purpose of determining FFCRA eligibility is to ensure that employees who qualify for paid sick leave and expanded family and medical leave under the FFCRA are able to receive the benefits they are entitled to.

What information must be reported on determining your ffcra eligibility?

The information reported on the FFCRA eligibility determination form typically includes the employee's name, qualifying reason for leave, requested leave dates, and any supporting documentation.

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