The Minnesota Paid Leave acknowledgment form is the signed or electronic receipt each employee returns after you deliver the individual written notice required by Minnesota Statutes section 268B.26. Download the state’s employee notice template from the Paid Leave Minnesota employer toolkit, fill in your company details and the 2026 premium split, deliver it to every worker, and keep the signed acknowledgment on file. Current employees had to receive the notice by December 1, 2025, and every new hire must receive it within 30 days of their start date.1Minnesota Office of the Revisor of Statutes. Minnesota Code 268B.26 – Notice Requirements If you haven’t distributed it yet, do it now. The program launched January 1, 2026, and penalties run per employee.
Where to Get the Form
The individual employee notice is published as a downloadable Word document on the Paid Leave Minnesota employer resource toolkit at pl.mn.gov.2Minnesota Paid Leave. Employer Resource Toolkit The .docx format lets you type your company-specific details directly into the template before printing or sending it electronically. The state publishes the notice in more than 40 languages, so you generally will not need to translate it yourself.
Use the state template. Drafting your own notice is legal but risks omitting one of the eight required items, and the template already carries the statutory language.
What Goes on the Form
Section 268B.26 requires every individual notice to include eight items:1Minnesota Office of the Revisor of Statutes. Minnesota Code 268B.26 – Notice Requirements
- An explanation of the family and medical leave benefits available under the program, including the employee’s rights to job reinstatement and continuation of health insurance during leave.
- The amount being deducted from the employee’s paycheck to fund the program.
- The employer’s own premium contribution and obligations.
- The employer’s name and mailing address.
- The employer identification number assigned by the Department of Employment and Economic Development (DEED).
- Instructions for filing a claim for leave benefits.
- DEED’s mailing address, email address, and phone number.
- Any additional information the department requires.
The template handles the fixed language for you. Your job is the variable fields.
Premium Figures
The total Paid Leave premium rate for 2026 is 0.88 percent of each employee’s wages.3Minnesota Department of Employment and Economic Development. Paid Leave Confirms Premium Rate, Remains on Track for Launch in 2026 Show both the employee’s share (the amount deducted from their paycheck) and the employer’s share. If your company chooses to cover more than the required employer portion, the notice needs to reflect the actual split you use. An error here can create payroll disputes later, so verify the numbers before you distribute.
Employer Details
Fill in your business name, mailing address, and the employer identification number DEED assigned when you registered with the program. If you have a designated contact for leave questions, add that name and phone number.
Language Requirements
The notice must be written in the employee’s primary language. Because DEED publishes the standard template in English, Hmong, Somali, Spanish, Vietnamese, and dozens of other languages, most employers can meet this requirement by pulling the correct-language version from the toolkit rather than commissioning a translation.2Minnesota Paid Leave. Employer Resource Toolkit
How to Deliver It and What Counts as Acknowledged
You can hand the notice to an employee in person or deliver it electronically through a secure HR portal, company email, or onboarding software. Delivery is complete only when the employee provides written or electronic acknowledgment of receipt.1Minnesota Office of the Revisor of Statutes. Minnesota Code 268B.26 – Notice Requirements A wet signature on a paper copy works. So does an “I acknowledge” click in your HR system, as long as the system logs the confirmation with a timestamp and the employee’s identity.
Emailing the notice without any tracking or return acknowledgment does not satisfy the requirement. If you send by email, use read receipts and require a reply, or route the notice through a system that captures a signed response.
Deadlines
Current Employees
The deadline to deliver the individual notice to all current employees was December 1, 2025, ahead of the program’s January 1, 2026 launch.4Minnesota Department of Employment and Economic Development. Paid Leave Updates for Employers If you missed it, distribute now. Each day without a completed acknowledgment on file for each worker adds exposure.
New Hires
Each new employee must receive the notice within 30 days of their start date.1Minnesota Office of the Revisor of Statutes. Minnesota Code 268B.26 – Notice Requirements Build it into your onboarding packet so it goes out with first-day paperwork rather than sitting on a checklist you check at day 29.
Keeping the Signed Acknowledgment
File every signed or electronically acknowledged notice with your personnel records. Section 268B.26 does not set a standalone retention period for these acknowledgments, but federal EEOC recordkeeping rules require employers to retain personnel and employment records for at least one year, and for one year after an involuntary termination.5U.S. Equal Employment Opportunity Commission. Recordkeeping Requirements Holding the acknowledgment for the full duration of each employee’s tenure, plus at least a year after separation, is the practical baseline, since a state audit can request proof of compliance at any time.
Penalties for Missing the Notice
The civil penalty is $50 per employee for a first violation of the notice requirement, and $300 per employee for each subsequent violation.1Minnesota Office of the Revisor of Statutes. Minnesota Code 268B.26 – Notice Requirements Because the fines are per employee, they scale quickly. For a 200-person workforce, a first offense would total $10,000, and a repeat failure would total $60,000.
If You Use an Approved Equivalent Plan
Employers with a state-approved equivalent private plan still have to comply with the section 268B.26 notice requirement. The private-plan notice must include the eight standard items and also affirm that the plan provides all the same rights and protections as the state-administered plan, describe the plan’s specific leave and employment protection benefits, and explain the employee’s appeal rights, including any optional alternatives to appealing through the state.6Cornell Law Institute. Minnesota Rule 3317.5100 – Notice of Coverage Under Private Plan Separate equivalent-plan templates are available on the Paid Leave Minnesota toolkit, currently in seven languages.2Minnesota Paid Leave. Employer Resource Toolkit
If you withdraw or terminate an equivalent plan, notify employees at least 30 days before the change using the standard state template, then send a follow-up within seven days of the transition confirming they are now covered under the state plan.7Minnesota Paid Leave. Equivalent Plans for Paid Leave
A Note on the Workplace Poster
The individual acknowledgment form does not replace the Paid Leave workplace poster, which must be displayed conspicuously at each worksite in English and in every other primary language spoken by five or more employees or contractors at that location, if the department publishes a translation.8Minnesota Office of the Revisor of Statutes. Minnesota Code 268B.26 – Notice Requirements Poster and individual notice are two separate obligations. You need both.