Emergency Paid Sick Leave (EPSL) Request Form Under ARPA

HR Compliance
Paid Sick Leave

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This sample form can be used to document information needed from an employee requesting emergency paid sick 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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