Family member's serious health condition, form WH-380-F (Spanish) - Use when a leave request is due to the medical condition of the employee's family member. Note: All requests for leave under the Family and Medical Leave Act require appropriate documentation (see the attached certification form).Step 4: Your employer must notify you whether your leave has been designated as FMLA within five business days. To request PFL, the employee requesting PFL must complete Part A of the Request For Paid Family Leave (Form PFL-1). This is a sample form for employees to request time off under the Family and Medical Leave Act. Correctly filled out Family and Medical Leave Act (FMLA) forms are critical for getting the time off from work to care for yourself or loved ones.