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Forms To File By Mail 

If you are filing the Request for Arbitration by mail, please mail a copy of the applicable form and all accompanying documentation to the below address. Please note that your Request for Arbitration will not be deemed complete until NAM receives the filing fee of $25.

NAM (National Arbitration and Mediation)
990 Stewart Avenue, First Floor
Garden City, NY 11530
Attention: PFL Arbitrations


Form No/ Version Date
Form Title

Who Files

Where to File

When to File
PFLA1
01/02/2018
Request For Arbitration (English)
Request For Arbitration (English) Applicant NAM and All Parties to the claim Within 26 weeks of written notice of denial of the claim for paid family leave
PFLA2
06/12/2018
Response to Request for Arbitration (English)
Response to Request for Arbitration (English) Respondent NAM and All Parties to the claim Within 14 days after receipt of acknowledgment of the complete Request for Arbitration from NAM
CC-1
02/21/2018
Credit Card Authorization Form
Credit Card Authorization Form

Form No/ Version Date
Título de la Planilla

Quién la presenta

Dónde presentarla

Cuándo presentarla
PFLA1-S
01/02/2018
Solicitud de Arbitraje (Español)
Solicitud de Arbitraje (Español) El solicitante NAM y todas las partes de la reclamación Dentro de las 26 semanas de notificación por escrito de la denegación de la reclamación por licencia familiar pagada

Form No/ Version Date
表格标题

提交人

提交地点

提交时间
PFLA1-C
01/02/2018
Request For Arbitration (C)
Request For Arbitration (C) 申请人 NAM 及与索赔相关的所有各方 在书面通知拒绝带薪家庭事假索赔后的 26 周内

Form No/ Version Date
Tit Fòm

Kiyès ki pou Anrejistre

Ki Bò pou Anrijistre

Ki Lè pou Anrejistre
PFLA1-H
01/02/2018
Request For Arbitration (H)
Request For Arbitration (H) Aplikan NAM ak Tout Pati reklamasyon an Nan peyòd 26 sèmen yo resevwa avi refi reklamasyon konje fanmi peye

Form No/ Version Date
Titolo del modulo

Chi presenta

Dove presentare

Quando presentare
PFLA1-I
01/02/2018
Request For Arbitration (I)
Request For Arbitration (I) Richiedente NAM e tutte le Parti alla richiesta Entro 26 settimane dalla notificazione scritta di rifiuto della richiesta di congedo familiare retribuito

Form No/ Version Date
양식 제목

제출인

제출처

제출 시기
PFLA1-K
01/02/2018
Request For Arbitration (K)
Request For Arbitration (K) 신청자 NAM 및 신청과 관련된 모든 당사자 유급 가족 휴가 신청에 대한 서면 거부 통지 후 26주 이내

Form No/ Version Date
Nazwa formularza

Kto składa

Gdzie złożyć

Kiedy złożyć
PFLA1-P
01/02/2018
Request For Arbitration (P)
Request For Arbitration (P) Wnioskodawca NAM i wszystkie strony związane z roszczeniem W ciągu 26 tygodni od pisemnego zawiadomienia o odmowie uznania roszczenia o płatny urlop rodzinny

Form No/ Version Date
Название формы

Кто подает

Куда подает

Срок подачи
PFLA1-R
01/03/2018
Request For Arbitration (R)
Request For Arbitration (R) Заявитель NAM и все указанные в заявлении стороны В течение 26 недель с момента направления письменного уведомления об отказе по заявлению об оплачиваемом отпуске по семейным обстоятельствам