Emergency Family and Medical Leave Expansion Act (EFMLA) Request Form Under ARPA

HR Compliance

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This sample form can be used to document information needed from an employee requesting emergency family and medical leave under the American Rescue Plan Act (ARPA) to substantiate eligibility for tax credits, per the IRS. Retain this documentation for four years from the date of the request. Covered employers can voluntarily provide these benefits from April 1, 2021, through September 30, 2021, and take the associated tax credit.

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