How to Fill Out and Submit the 1199SEIU Paid Family Leave Form (PFL-1)

To apply for benefits through the 1199SEIU National Benefit Fund, you file the New York Paid Family Leave Form PFL-1 together with the certification form that matches your reason for leave. The 1199SEIU Paid Family Leave form package goes to your employer first, who completes their portion and forwards everything to Amalgamated Employee Benefits Administrators (AEBA) for processing.¹ Approved claims pay 67 percent of your average weekly wage, capped at $1,228.53 per week in 2026, for up to 12 weeks per year.²

Confirm You Qualify Before You File

Three conditions decide eligibility through the National Benefit Fund. You must work for an employer that contributes to the NBF on your behalf, you must be classified as Wage Class I, II, or III under the fund’s plan rules, and you must have worked for that contributing employer for at least 26 weeks since your date of hire.¹ If your regular schedule will never let you hit the 26-week threshold, you may have signed an Employee Opt-Out form; opting out means you have no PFL benefits to claim.

Pick the Right Forms for Your Reason

Every request starts with Form PFL-1 (Request for Paid Family Leave). What you file alongside it depends on why you need leave.

Bonding With a New Child

Submit Form PFL-2 (Bonding Certification) with your PFL-1, plus documents that fit your situation:³

Birth parent: a copy of the child’s birth certificate, or a healthcare provider’s certification of birth if the certificate isn’t available yet.
Non-birth parent: a birth certificate naming you as the second parent, a Voluntary Acknowledgment of Parentage, or a Court Order of Filiation. Alternatively, the birth parent’s documentation plus proof of your relationship to the birth parent (marriage certificate, civil union, or domestic partnership document).
Adoption: court documents finalizing the adoption, or documentation showing the adoption is in progress. A second parent not named in the court papers also needs proof of the relationship to the named parent.
Foster care: the foster care placement letter from the county or city department of social services, or from an authorized foster care agency, plus relationship proof if the second parent isn’t named on the letter.

Caring for a Family Member With a Serious Health Condition

Three forms go together here: PFL-1, PFL-3, and PFL-4.⁴ The family member receiving care signs Form PFL-3 (Release of Personal Health Information) and gives it to their healthcare provider to keep on file; it authorizes the provider to share medical information tied to the leave request.⁵ The provider then completes Form PFL-4 (Health Care Provider Certification), documenting the condition and the need for your care.

Covered family members include a spouse, domestic partner, child, parent, grandparent, grandchild, sibling, and parent-in-law, among others. Check the current form instructions if your relationship isn’t on that short list.

Military Qualifying Event

When a family member is on active duty abroad, qualifying needs include attending military briefings, arranging childcare, and handling related legal or financial affairs. This leave uses Form PFL-5 (Military Qualifying Event).⁶ You’ll need to verify the service with covered active duty orders or a letter from the military unit confirming an impending call to duty. If your leave involves meeting with a third party (a counselor, school official, or care facility staff), include the name, address, and contact information of that person or entity, plus a description of the meeting.

How to Fill Out Form PFL-1

PFL-1 is split in two. Part A is yours. It asks for your identifying information, your employer’s name, and the details of your leave request: type of leave, dates you plan to take off, and whether the leave is continuous or intermittent. Fill every field. Blank entries are the most common reason claims get delayed.

Hand the form to your employer once Part A is done. Your employer fills out Part B with their business information and signs it, and by regulation must return the completed form to you within three business days.⁷ If your employer stalls, you don’t have to wait. Send the PFL-1 with only Part A completed, along with the rest of your package, directly to the carrier.⁵

Intermittent Leave

You don’t have to take all 12 weeks at once. New York PFL allows intermittent leave in increments of full workdays, and any day you work even partially does not count as a PFL day. List the specific dates on your PFL-1; leaving them blank can delay payment. Each intermittent absence must also be submitted to the carrier within 30 days.

Submitting the Package to AEBA

Give the full package to your employer. They complete Part B and forward everything to Amalgamated Employee Benefits Administrators, which handles PFL claims for the National Benefit Fund.¹ Employers transmit the package by fax to (914) 367-5374 or by email to 1199pfl@amalgamatedbenefits.com.⁸ For questions about your submission, call AEBA at (888) 447-9055.⁹

Notice Timing

Give your employer at least 30 days’ advance notice when the event is foreseeable, such as an expected birth, a planned surgery for a family member, or a known deployment. If 30 days isn’t practical because the situation changed suddenly or a medical emergency arose, give notice as soon as you can. Tell your employer right away if your dates shift or your leave gets extended.¹⁰

Before You Send

Copy everything before handing the package over. If you’re mailing directly to AEBA because your employer didn’t complete Part B in time, use certified mail so you have a dated delivery receipt. Check that names, dates, and Social Security numbers match across every form. Mismatches between PFL-1 and the certification forms are a frequent reason claims come back for correction.

After You Submit

Once AEBA has a completed application, it must pay or deny the claim within 18 calendar days of receiving the completed request or your first day of leave, whichever comes later.¹¹ If something is missing, the fund will contact you, and the 18-day clock resets once you supply it. Approved payments issue on a weekly or bi-weekly basis through direct deposit or a prepaid debit card, and you can check status by calling AEBA at (888) 447-9055. The NBF determines your benefit amount, distributes payments, and notifies your employer of the status of your request.⁸

If AEBA denies your claim or you disagree with the benefit amount, the denial notice must include the reason and instructions for requesting arbitration.¹¹ National Arbitration and Mediation (NAM) handles PFL disputes. File a request for review at nyspfla.namadr.com; a neutral arbitrator issues a binding decision, and the process costs you nothing to initiate.

1
1199SEIU Funds. Paid Family Leave
2
Paid Family Leave. New York Paid Family Leave Updates for 2026
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New York State Workers’ Compensation Board. Paid Family Leave to Bond with a Newly Born, Adopted, or Fostered Child
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New York State Paid Family Leave. Form Package for Family Care
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New York State Workers’ Compensation Board. How to Request Paid Family Leave
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New York State Workers’ Compensation Board. Paid Family Leave to Provide Assistance When a Family Member is Deployed
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The Standard. Applying for Paid Family Leave
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1199SEIU Funds. Paid Family Leave Benefit – National Benefit Fund
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1199SEIU National Benefit Fund. Paid Family Leave Form
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Cornell Law Institute. New York Code 12 NYCRR 380-3.1 – Employee Notice Requirements for Paid Family Leave
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Paid Family Leave. Handling Requests