GIT - Paid Family Leave

New York State Paid Family Leave

New York State Disability Paid Family Leave Insurance Data

Paid family Leave is NYS mandated and is a benefit that works hand in hand with your NYS Disability policy. This means if you have NYS Disability through NYSADA or any other carrier, you will also have Paid Family Leave. If you do not report data to us, we will be required to charge you the maximum amount which is $2.07 per person per week.The data you enter here will be used by NYSADA to pay the group Paid Family Leave Insurance for 2019 on a monthly basis and will be reflected on your bill as a monthly surcharge. As an example, use your 3rd quarter NYS-45 and estimate your 4th quarter data and submit below. If you have any questions please feel free to call 518-463-1148 (dial 0) .

Employer

Employer Name

Employer FEIN

Employee Contribution?

Do employees contribute to NYS Disability Premium? Y or N

Male Annual Wage Data

Total Number of MALE Employees Earning a Gross Annual Wage LESS THAN OR EQUAL TO $67,907.84:

Total Number of MALE Employees Earning a Gross Annual Wage GREATER THAN OR EQUAL TO $67,907.84:

Female Wage Data

Total Number of FEMALE Employees Earning a Gross Annual Wage LESS THAN OR EQUAL TO $67,907.84:

Total Number of FEMALE Employees Earning a Gross Annual Wage GREATER THAN OR EQUAL TO $67,907.84:

Total Gross Annual Wages – Male

Total All Gross Annual Wages of MALE Employees Earning LESS THAN OR EQUAL TO $67,907.84:

Total Gross Annual Wages – Female

Total All Gross Annual Wages of Female Employees Earning LESS THAN OR EQUAL TO $67,907.84

Submitter information

Submitter Name

Submitter Email

Submitter Telephone Number

Submit

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