FFCRA Sick and Family Leave Form

What’s New?

The U.S. Department of Labor has released the required information that employees must give their employers if they are in need of taking sick or family leave as a result of COVID-19, under the Families First Coronavirus Response Act. This information includes:

  • Employee’s name
  • Dates for which leave is requested
  • Qualifying reason for leave
  • Statement that the employee is unable to work because of qualified reason.

Required Additional Sick Leave Information

If the employee is requesting leave because of an isolation or quarantine order, the employee must provide the name of the government entity that issued the order.

If the employee is requesting leave because they are self-quarantined due to experiencing symptoms, and is seeking a medical diagnosis, the employee must provide the name of the health care provider.

Required Additional Family Leave Information

An employee requesting leave for child care must provide:

  • Name of the child being cared for
  • Name of the school, place of care or child care that is closed or unavailable because of COVID-19
  • A statement representing that no other suitable person is available to care for the child during the period of requested leave
  • If the employee is requesting leave to care for a person quarantined because of order, or because of medical reasons, the employee must provide the name of the applicable government entity or health care provider.

Tax Credits

In addition to this information, the employee must also provide documentation supporting the requested leave. In order to claim tax credits related to sick and family leave under the FFCRA, employers must maintain this information, and the related documentation for 4 years, regardless of whether the request for leave was granted. Additional documentation that employers who claim the tax credits must maintain include:

  • Form 941 for applicable quarters
  • Form 7200, Advance of Employer Credits Due to COVID-19
  • Any other applicable filings made to the IRS requesting the credit
  • Documentation to show employer determined the amount of qualified sick and family leave wages paid to employees (payroll history)
  • Documentation to show how the employer determined the amount of qualified health plan expenses allocated to wages

Learn more about our tools to help employers track payroll and health plan expenses related to sick and family leave under FFCRA, and will help their clients maintain required payroll information.

Author: Andy Scheu
Andy was just six years old when his father started Time & Pay and has watched it grow from a one-man show to an organization with more 15 employees, helping over 800 companies across the country. He was honored to become a part of Time & Pay in 2010 as an account executive and began growing their customer base in the Chattanooga, TN area. Now acting as Director of Marketing and Sales, Andy works to ensure that Time & Pay remains loyal to the mission established by its founder over 25 years ago..."to be the provider by choice of quality, cost effective Payroll, Timekeeping and HR solutions to businesses, that will maximize customer satisfaction, while maintaining our profitability.”

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