COVID-19
FFCRA Employer Forms
Coronavirus has had an impact on the ability of businesses to perform. It is prudent for businesses to review the information that may have lasting results on their relationships impacted by this pandemic.
FFCRA Employer Forms
In the absence of model forms from the government, IMA has endeavored to review DOL and IRS FAQs and a final rule to determine what employers need to request in order to claim the tax credit for the new EPSL. There is no password needed to unprotect the form and make edits. The processes we reviewed from regulators do not appear to need an actual document from a public health official or health care professional for EPSL purposes, just relying on the employee providing info and signing their attestation.
Sample EPSL Request Form
Employers with fewer than 500 employees (and employers of any size in the public sector) can utilize this form for employees to request EPSL. If you might deny a request, it’s still required to document the employee’s request for the leave. Remember, even a health care provider or emergency responder probably ought to be allowed to take EPSL if actually sick with COVID-19 and medically advised to isolate. This form is not an official “model” form and should be reviewed with your legal/tax counsel.
Download Sample EPSL Request Form
Download Sample EFML Request Form
Sample EFML Request Form
Use this form for employees to request EFML due to school/child care unavailability due to COVID-19. Even if you are an employer with fewer than 50 employees likely to claim a hardship exemption, you should still document the employee’s request for leave. We are providing you a sample form below to provide the employee a response. This form is not an official “model” form and should be reviewed with your legal/tax counsel.
Sample Employer Response Form
This form will help an employer provide a response indicating approval, revision, or denial of an employee’s emergency leave request. This form is not an official “model” form and should be reviewed with your legal/tax counsel.
Download Sample Employer Response Form
Download Sample Employer Emergency Paid Sick Leave (EPSL) Policy
Sample Employer Emergency Paid Sick Leave (EPSL) Policy
Sample Employer Emergency Family and Medical Leave (EFML) Expansion Policy
Download Sample Employer Emergency Family and Medical Leave (EFML) Expansion Policy
These samples should not be construed as legal or tax advice. We would strongly advise you run any sample form/policy by your own legal/tax advisor. Should you or your counsel desire to make changes to any of these samples, there is no password required to make edits to them.