Fillable Employee Notice of Paid Family Leave Payroll Deduction (New York State)

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Employee Notice of Paid Family Leave Payroll Deduction (New York State)

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Employee Notice of Paid Family Leave
Payroll Deduction for 2021
Employee Name ________________________________________________________
Employer Name ________________________________________________________
New York’s Paid Family Leave provides employees with job-protected, paid time o to bond
with a newly born, adopted, or fostered child, care for a family member with a serious health
condition, or assist loved ones when a family member is deployed abroad on active military
service. Paid Family Leave may also be available for use in situations when an employee or
their minor dependent child is under an order of quarantine or isolation due to COVID-19.
See PaidFamilyLeave.ny.gov/COVID19 for full details.
Employees pay for these benefits through a small payroll deduction, which is a percentage of
their wages up to a cap set annually. The 2021 payroll contribution is 0.511% of an employee’s
wages each pay period and is capped at an annual maximum of $385.34. Employees earning
less than the New York State Average Weekly Wage ($1450.17 per week), will have an annual
contribution amount less than the cap of $385.34, consistent with their actual weekly wages.
Based on your average pay period earnings of $ _____________. ________,
your estimated pay period deduction will be: $ _____________. ________.
Note: This deduction may fluctuate pay period to pay period, depending on your hours worked.
For more information, visit PaidFamilyLeave.ny.gov or call the
Paid Family Leave Helpline for assistance at (844) 337-6303.
PFL-PayDeduction-notice-2021 9-20
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Employee Notice of Paid Family Leave Payroll Deduction (New York State)

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Completed 14 March 2021

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