Begin | www.fmlataxcredit.org

Sick Leave 2020 Between April 1st and October 1st, 2020

Part I 2020. Did you miss any days due to mandated stay-at-home orders, COVID-19 illness, or to take care of someone during their illness?

Number of days off due to COVID-19 required care (Claim Up to 10 days)

Number of days off due to care for direct relative (Claim Up to 50 days)

Family Leave 2020

Part II 2020

Number of days off to care for a son or daughter, or relative in your immediate family (Claim Up to 50 days)

Sick Leave 2021. Between January 1st and April 1 2021

----------------------------------------------------------------------------------------------------------------------

Part l

Were you unable to do your job for up to 10 days due to your COVID-19 care?

Were you unable to do your job for up to 10 days to care for someone else?

List The Days Missed Here

Family Leave

Part lI Between January 1st and April 1 2021

Number of days off to care for a son or daughter, or relative in your immediate family (Claim Up to 50 days)

List The Days Missed Here

Sick Leave 2021

Part III

Did you miss any days due to mandated stay-at-home orders, COVID-19 illness, or to take care of someone during their illness?

Were you unable to do your job for up to 10 days due to your COVID-19 care?

Were you unable to do your job for up to 10 days Care for someone else?

List The Days Missed Here

Sick leave 2021. Between April 1st and October 1st 2021

Part IV

Were you unable to do your job for 60 days to care for a child? (Due to no school or daycare provider available)

Yes
No

Please include a list of days you needed to be off (If Between April 1, 2020 to December 31, 2021 you are eligible)

Full Name *

Email *

Phone *

Business Phone *

Fax

Please upload 2020, and 2021 Tax Returns

Click or drag files to this area to upload. You can upload up to 5 files.

Comment or Message

Let’s Get Started: Maximize Your Tax Credits

Sick Leave 2020 Between April 1st and October 1st, 2020

Part I 2020. Did you miss any days due to mandated stay-at-home orders, COVID-19 illness, or to take care of someone during their illness?

Family Leave 2020

Part II 2020

Sick Leave 2021. Between January 1st and April 1 2021

Part l

Family Leave

Part lI Between January 1st and April 1 2021

Sick Leave 2021

Part III

Sick leave 2021. Between April 1st and October 1st 2021

Part IV