FMLA Forms and the Submitting Process
FMLA Forms (Family Medical Leave Act) are now available below on our website. Please download the correct forms for your situation. If the FMLA claim is for your health condition you'll need the forms numbered HR-BEN-028 and HR-BEN-069. If the claim is for your family member's health condition you'll need the forms numbered HR-BEN-028 and HR-BEN-070. After printing out the forms you'll need to bring them to your doctor or your family member's doctor to fill out. When the forms are complete you should submit them to:
Tracy Ann Jeffers
MNR Human Resources 4th Floor
347 Madison Avenue
Telephone (212) 340-2658
Fax (212) 340- 2045
In her absence please contact : Lorenzo Biagia (212) 340-2455
If you need help or have any questions please contact the ACRE office.
New York Legislative Representative