Supplemental Pay Leave Request Form for Employees

**If you are intending to take Paid Family Leave (PFL) following your Short-Term Disability leave, an additional Supplemental Pay Leave Request form must be submitted for the PFL portion of your leave.

Short-term Disability (STD): Accruals are automatically processed in myURHR and will be applied in the following order, as outlined in each leave policy: Supplemental Vacation > Supplemental Sick > Vacation > Sick/Paid Time Off (PTO).

Paid Family Leave (PFL): Accruals are automatically processed in myURHR and will be applied in the following order, as outlined in each leave policy: Vacation > Sick/Paid Time Off (PTO).

Workers' Compensation: Accruals are automatically processed in myURHR and will be applied in the following order, as outlined in each leave policy: Supplemental Vacation > Supplemental Sick > Vacation > Sick/Paid Time Off (PTO).

Supplemental Pay Leave Request Form for Employees

Employee information

Attestation

Electronic Receipt of FMLA Correspondence While on Leave of Absence