Absolve as Administrator for Metropolitan Life Insurance Co.

City of New York PFL Basic Claim Submission Request

Para llenar esta solicitud en español, haga clic aquí.
Enter your name:
Enter the last 4 of your SSN:
Enter the tel. # number you would like to be contacted at:
What is the preferred time of day to contact you? (Our contact center hours are 8:30AM-5:00PM EST)
What is your preferred email address to receive required paperwork?
What is the reason for your PFL leave?
Will the leave be continuous or intermittent?
(intermittent means that you will be taking days periodically, not all in a row)
What will be the first day of your leave?
What will be the last day of your leave?

If you work for the Dept. of Education, all new claim requests must be submitted through SOLAS.
If you need to download PFL forms, please choose from the following:

If you work for NY Health + HospitalsIf you work for NYC but not in Health + Hospitals
NY Health and Hospitals PFL Bonding formNYC (not H&H) Bonding form
NY Health and Hospitals PFL Care of a Family Member formNYC (not H&H) Care of a Family Member form
NY Health and Hospitals PFL Military Caregiver formNYC (not H&H) Military Caregiver form

If you have already filled out your PFL forms, you can fax them to 800-728-7028 or 732-853-1762.