Medical Certification Form (PFL-MMC)

Question

Do you work in the District of Columbia or is your job based here?

Select an answer to continue.

Question 1 Y/N

No

Yes

Answer

DC Paid Family Leave is only available to people who work in the District of Columbia. It looks like you may not be eligible for benefits, but you should check with your employer to confirm your eligibility status. Your employer is required to tell you if your job is covered by DC Paid Family Leave.

Question

Do you work for one of the following employers?

The District Government
The Federal Government
The Washington Metropolitan Area Transit Authority (WMATA)
A Religious Institution

Select an answer to continue.

Question 2 Y/N

No

Yes

|

Answer

DC Paid Family Leave is only available to private-sector employees whose employer pays the PFL tax. It looks like you may not be eligible for benefits, but you should check with your employer to confirm your eligibility status. Your employer is required to tell you if your job is covered by DC Paid Family Leave.

Question

Based on your employment, it appears that you may be covered by DC Paid Family Leave. Now, let’s see if you experienced a qualifying event. Did you recently experience one of the following events? Or do you know that one of them will happen soon?

Medical care related to your pregnancy
Welcoming a new child into your family

This includes a baby being born into your family, adopting a child, or having a foster child placed with your family

A serious health condition or stillbirth

Eligible health conditions include conditions that cause an overnight stay at a hospital, conditions that cause an extended period of incapacity and a need for treatment, chronic conditions, incurable conditions, restorative surgeries, and preventative treatments.

Providing care for sick family member

Family members include children, parents, grandparents, siblings, or your spouse.

Select an answer to continue.

Question 3 Y/N

No

Yes

|

Answer

Sorry, it looks like you may not qualify. DC’s Paid Family Leave is here for you when you need time off work to care for yourself or a family member, to bond with a new child, or attend prenatal appointments.

Question

Does one of your family members have a serious health condition?

Family members include children, parents, grandparents, siblings, or your spouse.

Eligible health conditions include conditions that cause an overnight stay at a hospital, conditions that cause an extended period of incapacity and a need for treatment, chronic conditions, incurable conditions, restorative surgeries, and preventative treatments.

Select an answer to continue.

Question 4 Y/N

No

Yes

|

Answer

It looks like you may not be eligible for benefits. If you have any questions regarding your eligibility, please call 202-899-3700.

Question

Did you or your family member’s qualifying event happen already? Or will it happen soon?

Select an answer to continue.

Question 5 Y/N

Already happened

Happening soon

|

Answer

You may qualify for DC Paid Family Leave! Make sure you have what you need to apply by clicking below.

More Info

Answer

You won’t be able to file for DC Paid Family Leave until after your qualifying event happens, but you can still prepare now. Make sure you have what you need to apply by clicking below.

More Info

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Office of Paid Family Leave

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