PST Request Form – New York Payroll Associates

Paid Sick Time (PST) Request Form for New York:

Atrium Associates who work in New York as of September 30, 2020 are eligible to accrue leave at a rate of one hour for every 30 hours worked up to 56 hours under New York State / New York City Paid Safe and Sick Leave Law. On January 1, 2021, employees may start using accrued leave. A maximum of 56 hours of PST may be used in a calendar year. Atrium’s calendar year is defined as January 1 to December 31.

Paid sick time may be taken in one (1) hour increments. If the sick leave is foreseeable, you must verbally notify your immediate supervisor and Atrium counselor no more than seven days in advance of the need for leave. PST is paid at your current hourly rate.

After January 1, 2021, employees may use accrued leave following a verbal or written request to their employer for the following reasons impacting the employee or a member of their family for whom they are providing care or assistance with care:

Sick Leave:
- For mental or physical illness, injury, or health condition, regardless of whether it has been diagnosed or requires medical care at the time of the request for leave; or
- For the diagnosis, care, or treatment of a mental or physical illness, injury or health condition; or need for medical diagnosis or preventive care.

Safe Leave:
For an absence from work when the employee or employee’s family member has been the victim of domestic violence as defined by the State Human Rights Law, a family offense, sexual offense, stalking, or human trafficking due to any of the following as it relates to the domestic violence, family offense, sexual offense, stalking, or human trafficking:
- to obtain services from a domestic violence shelter, rape crisis center, or other services program;
- to participate in safety planning, temporarily or permanently relocate, or take other actions to increase the safety of the employee or employee’s family members;
- to meet with an attorney or other social services provider to obtain information and advice on, and prepare for or participate in any criminal or civil proceeding;
- to file a complaint or domestic incident report with law enforcement;
- to meet with a district attorney’s office;
- to enroll children in a new school; or
- to take any other actions necessary to ensure the health or safety of the employee or the employee’s family member or to protect those who associate or work with the employee.

You must be on an active assignment to be eligible for a PST payment. If your assignment ends at any point, earned but unused PST is not paid out. If you go back to work within one (1) year, and have met the eligibility requirements, you are able to use earned sick time accrued before the break in service.

*PST may only be requested in 1-hour increments up to 8 hours per day.

Associate Information

Name*

First Last

Client for which you are currently working:*

Phone*

Email*

Paid Sick Time Information

PLEASE INDICATE YOUR APPROVAL:*

Paid Sick Time Request: I am choosing to use PST

Date of PST Requested

Number of Hours Requested*

*PST may only be requested in 1-hour increments up to 8 hours per day

Additional Date of PST Requested

Number of Hours Requested

*PST may only be requested in 1-hour increments up to 8 hours per day

Additional Date of PST Requested

Number of Hours Requested

*PST may only be requested in 1-hour increments up to 8 hours per day

Reason for request:*

Sick Leave
Safe Leave

Eligibility Requirements:

Your PST request will be reviewed by Payroll to ensure eligibility requirements have been met. Please allow 7-14 business days for approval and processing of payment. If eligibility requirements are not met, Payroll will contact you.

pAId sick time request

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Associate Information

Paid Sick Time Information

Eligibility Requirements:

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