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San Jose, CA 95112-7709, 408-291-7730 The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. (1-866-487-9243), U.S. Department of Labor Choose how you want to receive or enter your security code. For additional security, we need to verify your identity before you can sign in to the account. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} Suite 605 1-866-4-USWAGE We offer a holistic approach to Leave, blending responsive digital tools and on-call advocates to help employees feel empowered and in control of their claim. (1-866-487-9243), U.S. Department of Labor .h1 {font-family:'Merriweather';font-weight:700;} If you work in Allegheny and Garrett counties, see Charleston District Office. 500 Quarrier St I have many more example of this pattern of behavior from The Hartford. All Paid Family Leave Forms Filter Options Suite 1104 Wage and Hour Division 1-866-4-USWAGE Manage my business policy, bills and claims, get certificates and submit audits. 8701 S Gessner Dr Wage and Hour Division Note: If you have been denied unemployment benefits, file an appeal here. (1-866-487-9243), U.S. Department of Labor For a sick/disability absence involving more than seven calendar days, employees must call Hartford, our STD insurance carrier, at (866) 548-3101. If you work in Southwestern Virginia, see Charleston District Office. 606 N Carancahua St Albany, NY 12207, 518-431-6460 #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} You can also contact us by email by visiting WHD online at https://webapps.dol.gov/contactwhd. (1-866-487-9243), 1 Church St Suite 300 FMLA is designed to help employees balance their work and family responsibilities by allowing them to take reasonable unpaid leave for certain family and medical reasons. Employers may create their own forms; they must contain the information required by the regulations. 1-866-4-USWAGE .agency-blurb-container .agency_blurb.background--light { padding: 0; } The Hartford's Absence Management solutions offer your employees digital tools and on-call advocates to manage Leave and Disability claims with care and helpful resources. 600 South Maestri Place Age of Family Members (if applicable): Enter one: Number of Family Members (if applicable): Enter the range of numbers and the numbers should be between 1 and 4 if possible. Skimming through can give you a heads-up on what to expect based on other employers experiences. The CT Family and Medical Leave Act provides eligible employees with job-protected leave, and the CT Paid Leave Act provides eligible workers with income replacement. Mountainside, NJ 07092, (908) 317-8611 JOB DESCRIPTION. 1-866-4-USWAGE If you work in American Samoa, please see the Honolulu District Office. Phone Number; Fair Labor Standards Act (FLSA) 1-866-487-9243* Family Medical and Leave Act (FMLA) 202-693-0066. Prior to January 15th, file your complainthere. 7 1205 Texas Avenue (1-866-487-9243), U.S. Department of Labor Employer Identification Number: Employee #: Relation to Employee: Employee name is not part of the Employer's identification number. For additional information, visit the Wage and Hour Division Website, http://www.wagehour.dol.gov and/or call our toll-free helpline, 1-866-4-USWAGE (1-866-487-9243) available 8 a.m. to 5 p.m. in your time zone. To meet the general notice requirements of the FMLA, covered employers must display a poster in plain view for all workers and applicants to see, notifying them of the FMLA provisions and providing information concerning how to file a complaint with the Wage and Hour Division. (1-866-487-9243), U.S. Department of Labor Wage and Hour Division Although the Department of Labor makes every effort to provide quality information, it makes no claims, promises or guarantees about the accuracy or completeness of the information contained herein. (1-866-487-9243), U.S. Department of Labor The .gov means its official. #block-googletagmanagerheader .field { padding-bottom:0 !important; } 1-866-4-USWAGE Washington, DC 202101-866-4-USA-DOL1-866-487-2365www.dol.gov, Industry-Recognized Apprenticeship Programs (IRAP), Employee Benefits Security Administration (EBSA), Employment and Training Administration (ETA), Office of Congressional and Intergovernmental Affairs (OCIA), Office of the Assistant Secretary for Administration and Management (OASAM), Office of the Assistant Secretary for Policy (OASP), Office of the Chief Financial Officer (OCFO), Ombudsman for the Energy Employees Occupational Illness Compensation Program (EEOMBD), Pension Benefit Guaranty Corporation (PBGC), Economic Data from the Department of Labor. 200 Sheffield Street, Room 102 CT Family and Medical Leave (CTFMLA) and CT Paid Leave (CTPL) are two separate laws to help eligible workers who need to take leave from their job to care for a loved one or for their own medical reasons. Taunton, MA 02780, (508) 821-9106 Columbus, OH 43215-2408, 614-469-5678 Inform the employee of his or her eligibility status; and. Text {#maskedTwoFactorSMS} Hagatna, GU 96910-4950, 671-473-9178 (1-866-487-9243), 770 The City Drive S 1-866-4-USWAGE An official website of the United States government. Estimates vary for the percentage of covered employees who use FMLA every year, but the most widely cited number is 14.5%. An employer who willfully violates this posting requirement may be subject to a civil money penalty. Notice of Eligibility and Rights and Responsibilities, Medical Certification for Employees Serious Health Condition, Medical Certification for Care of a Family Members Serious Health Condition, Medical Certification for Serious Injury or Illness of a Servicemember for Military Caregiver Leave, Whats the process for filing an Appeal with CT Paid Leave, Connecticut Paid Family & Medical Leave (ctpaidleave.org), CONNECTICUT GENERAL STATUTE 31-57r PAID SICK LEAVE (state.ct.us), File a New Family & Medical Leave Complaint. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. New York. 104 Dean Street, Room 201 1-866-4-USWAGE 1-866-4-USWAGE .paragraph--type--html-table .ts-cell-content {max-width: 100%;} Dallas, TX 75202, 817-861-2150 p.usa-alert__text {margin-bottom:0!important;} (1-866-487-9243), U.S. Department of Labor Tampa, FL 33607, (813) 288-1242 .h1 {font-family:'Merriweather';font-weight:700;} Wage and Hour Division It could be because it is not supported, or that JavaScript is intentionally disabled. Wage and Hour Division Room 101 Wage and Hour Division Room 1072 06-0646668). 325 John Knox Road Long Term and FMLA claims . Time taken off work due to pregnancy complications can be counted against the 12 weeks of family and medical leave. (1-866-487-9243), U.S. Department of Labor The information set forth on, and linked through, this website is designed to provide a service to the employers and employees of this state. The maximum number of family members for which a request can be made is 4. The FMLA Advisor provides information about employee eligibility under the law; including valid reasons for leave; employee/employer notification responsibilities; and employee rights and benefits. 1-866-4-USWAGE Wilkes Barre, PA 18702-5284, 570-826-6316 @media only screen and (min-width: 0px){.agency-nav-container.nav-is-open {overflow-y: unset!important;}} Note: Incomplete, wrong, duplicate or misleading responses will result in denial of the certification. Chicago, IL 60604-1591, (312) 789-2950 If you are unable to find the information you need on this page, you can contact the CTDOL Legal Division atDOL.CTFMLA@ct.gov. An employee is entitled to be reinstated to the employees same position or, if the same position is no longer available, to an equivalent position upon returning from CTFMLA leave. If you work in Alaska, please see the Seattle District Office. Somerset Bank Building Canton, MA 02021 Note: An employee can request this leave for a family member only after the employee has entered the FMLA disability status on a certified medical certificate with his/her supervisor. You can watch ourInformational webinarand review ourPowerPointslideshow for more detailed information about the Connecticut Family & Medical Leave Act. Benefits and Costs of the Family and Medical Leave Act PDF, The Equal Employment Opportunity Commission (EEOC), Find out more information about third party resources, Fortunately, the learning curve for FMLA basics is not steep. 620 SW Main St Jacksonville, FL 32202, (904) 359-9292 950 22nd St N Employers may use Form WH-382, which is available at no cost from the WHD website at www.dol.gov/agencies/whd/fmla, to provide this designation notice. 2300 Clarendon Blvd, Suite 503 202-693-0103. 224 S Boulder Ave Please check your spelling or try another term. Notify your employer 1-866-4-USWAGE Wage and Hour Division Wage and Hour Division Wage and Hour Division For more information, click here. 1-866-4-USWAGE New Orleans, LA 70130, (504) 589-6171 To care for a spouse, son, daughter, parent or next of kin with a serious injury or illness incurred on active duty in the armed forces. Ste. 1-866-4-USWAGE .paragraph--type--html-table .ts-cell-content {max-width: 100%;} This was the first job . Submit claims, check status of disability or leave, and see payments. Providence, RI 02903, 401-528-4431 FMLA Poster Social Security Waiver. Family Leave - to care for a seriously ill child, spouse, or parent. Federal Contract Compliance Assistance. 2. U.S. Department of Labor Charleston, WV 25301-2130, 304-347-5206 If you are unable to find the information you need on this page, you can contact the CTDOL Legal Division at DOL.CTFMLA@ct.gov . (1-866-487-9243). Employees who have been denied compensation under the CT Paid Leave Insurance Program, or any person who has been assessed a penalty by the CT Paid Leave Authority, may file an appeal with the Connecticut Department of Labor (CTDOL) Appeals Division. You are about to be logged out due to inactivity. Wage and Hour Division 1000 Liberty Ave Syracuse, NY 13261, 315-448-0630 /*-->