The CT Paid Leave Employment Verification Form is the document your employer fills out to confirm your hire date, weekly schedule, earnings, and any other income you’ll receive during leave, so Aflac can calculate your weekly benefit. You don’t complete most of it yourself. After you file your claim, you hand the form to your employer, and then you make sure the completed version gets back to Aflac before your deadline.1Connecticut Paid Leave. I Am an Employer Speed on this step is one of the biggest factors in how quickly your benefits start.
What Your Employer Fills In
The form has several sections, and almost all of them are your employer’s responsibility. Knowing what belongs in each one helps you catch mistakes before they cost you money.
Employer Identification
Your employer enters the company name, address, and Federal Employer Identification Number. The FEIN is what links your claim to your employer’s records inside the CT Paid Leave system, and an incorrect FEIN is one of the most common reasons claims stall.2Connecticut Paid Leave. CT Paid Leave Employment Verification Form
Hire Date, Schedule, and Earnings
Your employer reports when you were hired, your typical weekly hours, and your earnings. If you work a standard schedule, they list that number; if your hours vary, they provide an average.2Connecticut Paid Leave. CT Paid Leave Employment Verification Form When the reported hours don’t match what you actually work, your weekly benefit comes out too high or too low, and you’ll usually need to submit pay stubs to correct it.
Other Income During Leave
Your employer also has to disclose any other income you’ll receive while on leave: paid time off, sick leave, vacation pay, short-term disability, or distributions from an employer-sponsored retirement plan. CT Paid Leave benefits combined with employer-provided benefits cannot exceed your regular wages, and if the total would go over that cap, your paid leave benefit gets reduced.3CT Paid Leave Authority. Frequently Asked Questions An employer may require you to use accrued PTO concurrently with CT Paid Leave, or let you choose, but the combined amount can’t exceed your normal pay.4Connecticut Paid Leave. CT Paid Leave and FMLA
Why the Numbers on the Form Matter
The wages and hours your employer reports feed straight into the benefit calculation. As of January 1, 2026, the formula works like this:5Connecticut Paid Leave. Before You Apply
- Your average weekly wage is the sum of your two highest-earning quarters in the base period, divided by 26, rounded down to the nearest whole dollar.
- If that average weekly wage is $677.60 or less (40 times the Connecticut minimum wage), your weekly benefit is 95% of it.
- If it’s above $677.60, your benefit is 95% of $677.60 plus 60% of the amount above $677.60.
- No weekly benefit can exceed $1,016.40, which is 60 times the Connecticut minimum wage.
If the earnings or hours reported on the verification form are wrong, so is your benefit. That’s why it’s worth reviewing the completed form before it goes back to Aflac, if your employer will let you.
Getting Your Employer to Complete It on Time
After you file your claim at ctpaidleave.org or by calling Aflac at (877) 499-8606, you’ll receive the Employment Verification Form along with the rest of your required documents.6Connecticut Paid Leave. Apply for Benefits Get it to your employer right away. Every covered employer is legally required to complete and return the form by your claim deadline, even if you no longer work there.1Connecticut Paid Leave. I Am an Employer
Once your employer receives the form, they have 10 days to complete it and return it to Aflac.7Connecticut Paid Leave. Employment Verification Form Job Aid If they don’t respond, contact Aflac and explain what you’ve done to make sure your employer understood the obligation. If that still doesn’t move things, the CT Paid Leave Authority can issue a subpoena to compel a non-cooperating employer to provide the information.3CT Paid Leave Authority. Frequently Asked Questions An unresponsive employer is not a dead end.
How to Submit the Completed Form to Aflac
Once the form is filled in, it needs to reach Aflac. There are three ways to send it:8Connecticut Paid Leave. Application Document Checklist
- Upload a photo or scan through the online CT Paid Leave Aflac portal. This is the fastest option and gives you immediate confirmation that it was received.
- Fax it to (888) 485-0973 and keep the transmission confirmation.
- Mail it to Aflac Administrative Office, Columbus, GA 31908-4077. Use a tracked service if you go this route, since paper mail introduces transit time and the possibility of loss.
If you need more time to gather the form or your other documents, you can contact Aflac directly to request an extension.6Connecticut Paid Leave. Apply for Benefits
What Happens Next
Once Aflac has everything it needs, including your medical certification and identity verification, the review takes about five business days.9Connecticut Paid Leave. After You Apply The catch is that the clock only starts when the file is complete. If the verification form has the wrong FEIN, inaccurate hours, or a missing signature, the review pauses until it’s fixed. Most delays trace back to the form itself, not to slow processing.
During the review, Aflac verifies the employer’s FEIN, confirms your reported hours and earnings, and checks whether any other income you’ll be receiving affects your benefit amount. You can watch your claim status through the online portal dashboard.
The Form Doesn’t Protect Your Job
One thing the Employment Verification Form and CT Paid Leave in general do not do: hold your job for you. The program is strictly income replacement. Job protection comes from a separate application to your employer under the federal Family and Medical Leave Act or the Connecticut FMLA, and filing for CT Paid Leave does not automatically trigger either one. The two programs can run concurrently when both apply, but you have to request FMLA separately. If you’re not eligible for FMLA, ask about protections under other laws such as the Americans with Disabilities Act or the Connecticut Fair Employment Practices Act.4Connecticut Paid Leave. CT Paid Leave and FMLA