Request for Benefits Provided Under the Families First Coronavirus Relief Act

  • To request benefits that are provided under the Families First Coronavirus Response Act (FFCRA):

    • You must complete the FFCRA Benefit Request Form.
    • Read the entire form.
    • Complete this form and submit to human resources.
    • Send requested documentation in with the form, if possible. You will receive an email back once your leave request has been approved or denied.
    • If your leave is going to be over 10 consecutive work days, you must follow the process to request a Leave of Absence

    NOTE: Human Resources may need to ask for additional information to determine FFCRA eligibility 

    Prior to your return:

    • Notify Human Resources prior to your return to work.
    • Provide documentation that you are medically cleared to return, and stating any limitations or restrictions, if applicable.