Paid Family Leave Waiver for State Employees

State employees can claim exemption from NYS Paid Family Leave (PFL) eligibility.

An employee must meet certain criteria to file a PFL waiver. 

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Sign form on Employee's Signature line
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:

Human Resources
University at Buffalo
Townsend Hall
205 Hayes Road
Buffalo, NY 14214

Need Help Completing the Form?


UB HR Benefits

State Benefit Services

Phone: 716-645-7777


Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: February 2020

Owner:  State Benefits, Human Resources