paidleavecontact.oregon.gov
Open in
urlscan Pro
104.16.51.111
Public Scan
URL:
https://paidleavecontact.oregon.gov/hc/en-us/requests/new
Submission: On April 03 via api from US — Scanned from DE
Submission: On April 03 via api from US — Scanned from DE
Form analysis 3 forms found in the DOM
POST https://paidleave.oregon.gov/search/
<form action="https://paidleave.oregon.gov/search/" method="post" role="form" class="">
<div class="row">
<div class="col-9 form-group">
<input type="text" name="query" class="form-control mobile-search-input" id="query" placeholder="Search for..." required="">
</div>
<div class="col-3 form-group pt-md-1 ps-0">
<button type="submit" class="btn header-btn-green">Search</button>
</div>
<div id="language"></div>
</div>
</form>GET /hc/en-us/search
<form role="search" class="search" data-search="" action="/hc/en-us/search" accept-charset="UTF-8" method="get"><input name="utf8" type="hidden" value="✓" autocomplete="off"><input type="search" name="query" id="query" placeholder="Search"
aria-label="Search"><button type="button" aria-controls="query" class="clear-button"><svg xmlns="http://www.w3.org/2000/svg" width="12" height="12" focusable="false" role="img" viewBox="0 0 12 12" aria-label="Clear search">
<path stroke="currentColor" stroke-linecap="round" stroke-width="2" d="M3 9l6-6m0 6L3 3"></path>
</svg></button></form>POST /hc/en-us/requests
<form id="new_request" class="request-form" data-form="" data-form-type="request" action="/hc/en-us/requests" accept-charset="UTF-8" method="post"><input name="utf8" type="hidden" value="✓" autocomplete="off">
<input type="hidden" name="request[ticket_form_id]" id="request_ticket_form_id" value="6204281717527" autocomplete="off">
<div class="form-field string required request_anonymous_requester_email"><label for="request_anonymous_requester_email">Your email address</label>
<input type="text" name="request[anonymous_requester_email]" id="request_anonymous_requester_email" aria-required="true">
</div>
<div class="form-field string required request_custom_fields_1500001465682">
<label id="request_custom_fields_1500001465682_label" for="request_custom_fields_1500001465682">Name</label>
<input type="text" name="request[custom_fields][1500001465682]" id="request_custom_fields_1500001465682" aria-required="true" aria-describedby="request_custom_fields_1500001465682_hint" aria-labelledby="request_custom_fields_1500001465682_label">
<p id="request_custom_fields_1500001465682_hint">First and Last Name</p>
</div>
<div class="form-field string required request_custom_fields_1500002269362">
<label id="request_custom_fields_1500002269362_label" for="request_custom_fields_1500002269362">Preferred language</label>
<input type="hidden" name="request[custom_fields][1500002269362]" id="request_custom_fields_1500002269362" value="noneselected" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"None selected","value":"noneselected","selected":true},{"label":"Afghan","value":"afghan"},{"label":"Afrikaans","value":"afrikaans"},{"label":"Albanian","value":"albanian"},{"label":"አማርኛ (Amharic)","value":"amharic"},{"label":"عربي(Arabic)","value":"arabic"},{"label":"Armenian","value":"armenian"},{"label":"Bosnian","value":"bosnian"},{"label":"Braille","value":"braille"},{"label":"Burmese","value":"burmese"},{"label":"Cambodian","value":"cambodian"},{"label":"繁體中文 (Traditional Chinese)","value":"cantonese"},{"label":"Choa Chow","value":"choa_chow"},{"label":"Czech","value":"czech"},{"label":"Danish","value":"danish"},{"label":"Dutch","value":"dutch"},{"label":"English","value":"english"},{"label":" فارسی (Farsi)","value":"farsi"},{"label":"French","value":"french"},{"label":"Gaelic","value":"gaelic"},{"label":"German","value":"german"},{"label":"Greek","value":"greek"},{"label":"Hawaiian","value":"hawaiian"},{"label":"Hearing Loss","value":"hearingloss"},{"label":"Hebrew","value":"hebrew"},{"label":"Hindi","value":"hindi"},{"label":"Hmong","value":"hmong"},{"label":"Hungarian","value":"hungarian"},{"label":"Italian","value":"italian"},{"label":"Japanese","value":"japanese"},{"label":"한국어 (Korean)","value":"korean"},{"label":" ຮັບການຊ່ວຍເຫຼືອເປັນພາສາລາວ (Laotian)","value":"laotian"},{"label":"简体中文 (Simplified Chinese)","value":"mandarin"},{"label":"Marshallese","value":"marshallese"},{"label":"Mien","value":"mien"},{"label":"Mixtec","value":"mixtec"},{"label":"Norwegian","value":"norwegian"},{"label":"Persian","value":"persian"},{"label":"Polish","value":"polish"},{"label":"Portuguese","value":"portuguese"},{"label":"Punjabi","value":"punjabi"},{"label":"Romanian","value":"romanian"},{"label":"Русский (Russian)","value":"russian"},{"label":"Samoan","value":"samoan"},{"label":"Serbo Croatian","value":"serbocroatian"},{"label":"Sign Language","value":"signlanguage"},{"label":"Soomaali (Somali)","value":"somali"},{"label":"Español (Spanish)","value":"spanish"},{"label":"Swedish","value":"swedish"},{"label":"Tagalog","value":"tagalog"},{"label":"Tao Chiew","value":"taochiew"},{"label":"Thai","value":"thai"},{"label":"Tigre","value":"tigre"},{"label":"Tigrinia","value":"tigrinia"},{"label":"Toishanese","value":"toishanese"},{"label":"Tongan","value":"tongan"},{"label":"Triqui","value":"triqui"},{"label":"Turkish","value":"turkish"},{"label":"Ukrainian","value":"ukrainian"},{"label":"Tiếng Việt (Vietnamese)","value":"vietnamese"},{"label":"Welsh","value":"welsh"},{"label":"Yiddish","value":"yiddish"},{"label":"Yugoslavic","value":"yugoslavic"},{"label":"Zapotec","value":"zapotec"},{"label":"Other","value":"other"}]"
aria-required="true"
aria-labelledby="request_custom_fields_1500002269362_label"><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_tujfdvd3n" aria-required="true" aria-labelledby="request_custom_fields_1500002269362_label" style="max-width: 100%;">None selected</a>
</div>
<div class="form-field string optional request_custom_fields_1500001784482">
<label id="request_custom_fields_1500001784482_label" for="request_custom_fields_1500001784482">Phone Number<span class="optional">(optional)</span></label>
<input type="text" name="request[custom_fields][1500001784482]" id="request_custom_fields_1500001784482" aria-required="false" aria-describedby="request_custom_fields_1500001784482_hint"
aria-labelledby="request_custom_fields_1500001784482_label">
<p id="request_custom_fields_1500001784482_hint"> Phone Number (ex. 5555555555 (must be a 10 digit number without spaces or dashes))</p>
</div>
<div class="form-field boolean optional request_custom_fields_9413249567127">
<label id="request_custom_fields_9413249567127_label" for="request_custom_fields_9413249567127">I do not have a question, I only want to give feedback about Paid Leave Oregon<span class="optional">(optional)</span></label>
<input name="request[custom_fields][9413249567127]" type="hidden" value="off" autocomplete="off"><input aria-required="false" aria-labelledby="request_custom_fields_9413249567127_label" type="checkbox" value="on"
name="request[custom_fields][9413249567127]" id="request_custom_fields_9413249567127">
</div>
<div class="form-field string request_custom_fields_7151927599639 required">
<label id="request_custom_fields_7151927599639_label" for="request_custom_fields_7151927599639">I am…</label>
<input type="hidden" name="request[custom_fields][7151927599639]" id="request_custom_fields_7151927599639" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"An Employer","value":"employer__i_am_an_employer_representative_paidleave"},{"label":"An Employee","value":"__dc.an_employee_paidleave__"},{"label":"Self-Employed","value":"i_am_self_employed_paidleave"},{"label":"Other Organization","value":"__dc.other_organization_paidleave__"}]"
aria-required="true" aria-labelledby="request_custom_fields_7151927599639_label"
value=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_4cb808l4w" aria-required="true" aria-labelledby="request_custom_fields_7151927599639_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7152243398551" hidden="">
<label id="request_custom_fields_7152243398551_label" for="request_custom_fields_7152243398551">Employer size</label>
<input type="hidden" name="request[custom_fields][7152243398551]" id="request_custom_fields_7152243398551" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"I have fewer than 25 employees","value":"__dc.less_than_25_employees_paidleave__"},{"label":"I have 25 or more employees","value":"__dc.25_or_more_employees_paidleave__"},{"label":"I have a question about how to determine employer size","value":"__dc.i_have_a_question_about_how_to_determine_employer_size_paidleave__"}]"
aria-required="false" aria-labelledby="request_custom_fields_7152243398551_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_v331te3c6" aria-required="false" aria-labelledby="request_custom_fields_7152243398551_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7178066039575" hidden="">
<label id="request_custom_fields_7178066039575_label" for="request_custom_fields_7178066039575">I have a question about…</label>
<input type="hidden" name="request[custom_fields][7178066039575]" id="request_custom_fields_7178066039575" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"Benefits","value":"__dc.benefits_paidleave__oo"},{"label":"Contribution rates","value":"__dc.contribution_rates_paidleave__oo"},{"label":"Equivalent plans","value":"__dc.equivalent_plans_paidleave__"},{"label":"Paid Leave law and rule","value":"__dc.paid_leave_law_and_rule_paidleave__"},{"label":"Requesting a presentation","value":"__dc.requesting_a_presentation_paidleave__oo"},{"label":"Other","value":"__dc.other_paidleave__oo"}]"
aria-required="false" aria-labelledby="request_custom_fields_7178066039575_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_sk664453u" aria-required="false" aria-labelledby="request_custom_fields_7178066039575_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7176663381655" hidden="">
<label id="request_custom_fields_7176663381655_label" for="request_custom_fields_7176663381655">I have a question about…</label>
<input type="hidden" name="request[custom_fields][7176663381655]" id="request_custom_fields_7176663381655" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"My requirement to participate","value":"__dc.my_requirement_to_participate_paidleave__l"},{"label":"Benefits","value":"__dc.benefits_paidleave__l"},{"label":"Contribution rates","value":"__dc.contribution_rates_paidleave__l"},{"label":"What are considered wages (tips, commission, etc.)","value":"__dc.what_are_considered_wages_paidleave__l"},{"label":"Equivalent plans","value":"__dc.equivalent_plans_paidleave__l"},{"label":"Job protection","value":"__dc.job_protection_paidleave__l"},{"label":"Notice posting requirements","value":"__dc.notice_posting_requirements_paidleave__l"},{"label":"Requesting a presentation","value":"__dc.requesting_a_presentation_paidleave__l"},{"label":"Other","value":"__dc.other_paidleave__l"}]"
aria-required="false" aria-labelledby="request_custom_fields_7176663381655_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_0b8btzgjx" aria-required="false" aria-labelledby="request_custom_fields_7176663381655_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7177704313623" hidden="">
<label id="request_custom_fields_7177704313623_label" for="request_custom_fields_7177704313623">I have a question about…</label>
<input type="hidden" name="request[custom_fields][7177704313623]" id="request_custom_fields_7177704313623" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"My eligibility","value":"__dc.my_eligibility_paidleave___se"},{"label":"Benefits","value":"__dc.benefits_paidleave__se"},{"label":"Choosing coverage","value":"__dc.choosing_coverage_paidleave__"},{"label":"Termination of coverage","value":"__dc.termination_of_coverage_paidleave__"},{"label":"Reporting requirements","value":"__dc.reporting_requirements_paidleave__se"},{"label":"Other","value":"__dc.other_paidleave__se"}]"
aria-required="false" aria-labelledby="request_custom_fields_7177704313623_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_l2ms6revf" aria-required="false" aria-labelledby="request_custom_fields_7177704313623_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7176575994263" hidden="">
<label id="request_custom_fields_7176575994263_label" for="request_custom_fields_7176575994263">I have a question about…</label>
<input type="hidden" name="request[custom_fields][7176575994263]" id="request_custom_fields_7176575994263" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"My requirement to participate","value":"__dc.my_requirement_to_participate_paidleave__"},{"label":"Assistance grants","value":"__dc.assistance_grants_paid_leave__"},{"label":"Benefits","value":"__dc.benefits_paidleave__"},{"label":"Contribution rates","value":"__dc.contribution_rates_paidleave__"},{"label":"What are considered wages (tips, commission, etc.)","value":"__dc.what_are_considered_wages_paidleave__"},{"label":"Job protection","value":"__dc.job_protection_paidleave__"},{"label":"Notice posting requirements","value":"__dc.notice_posting_requirements_paidleave__"},{"label":"Requesting a presentation","value":"__dc.requesting_a_presentation_paidleave__"},{"label":"Other","value":"__dc.other_paidleave__"}]"
aria-required="false" aria-labelledby="request_custom_fields_7176575994263_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_efza9aqwd" aria-required="false" aria-labelledby="request_custom_fields_7176575994263_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7177620233495" hidden="">
<label id="request_custom_fields_7177620233495_label" for="request_custom_fields_7177620233495">I have a question about…</label>
<input type="hidden" name="request[custom_fields][7177620233495]" id="request_custom_fields_7177620233495" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"My eligibility","value":"__dc.my_eligibility_paidleave__"},{"label":"Benefits","value":"__dc.benefits_paidleave__e"},{"label":"Contributions","value":"__dc.contributions_paidleave__"},{"label":"Job protection","value":"__dc.job_protection_paidleave__e"},{"label":"The application process","value":"__dc.the_application_process_paidleave__"},{"label":"Documenting my “qualifying event” for paid leave benefits","value":"__dc.documenting_my_qualifying_event_for_paid_leave_benefits_paidleave__"},{"label":"Responsibilities of notification to employer (and related penalties)","value":"__dc.responsibilities_of_notification_to_employer_and_related_penalties__paidleave__"},{"label":"Right to an authorized representative","value":"__dc.right_to_an_authorized_representative_paidleave__"},{"label":"Other","value":"__dc.other_paidleave__e"}]"
aria-required="false" aria-labelledby="request_custom_fields_7177620233495_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_l3o9x031p" aria-required="false" aria-labelledby="request_custom_fields_7177620233495_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7177426946583" hidden="">
<label id="request_custom_fields_7177426946583_label" for="request_custom_fields_7177426946583">Benefits</label>
<input type="hidden" name="request[custom_fields][7177426946583]" id="request_custom_fields_7177426946583" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"How much will I get paid?","value":"__dc.how_much_will_i_get_paid_paidleave__"}]" aria-required="false"
aria-labelledby="request_custom_fields_7177426946583_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_2xf1vcy0h" aria-required="false" aria-labelledby="request_custom_fields_7177426946583_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7177914687383" hidden="">
<label id="request_custom_fields_7177914687383_label" for="request_custom_fields_7177914687383">Contribution rates</label>
<input type="hidden" name="request[custom_fields][7177914687383]" id="request_custom_fields_7177914687383" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"Method to determine contribution rate","value":"__dc.method_to_determine_contribution_rate_paidleave__"},{"label":"Method to determine maximum wage amount","value":"__dc.method_to_determine_maximum_wage_amount_paidleave__"}]"
aria-required="false" aria-labelledby="request_custom_fields_7177914687383_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_j2twrio0r" aria-required="false" aria-labelledby="request_custom_fields_7177914687383_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7177837999767" hidden="">
<label id="request_custom_fields_7177837999767_label" for="request_custom_fields_7177837999767">Equivalent plans</label>
<input type="hidden" name="request[custom_fields][7177837999767]" id="request_custom_fields_7177837999767" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"Plan requirements","value":"__dc.plan_requirements_paidleave__"},{"label":"Recordkeeping","value":"__dc.record_keeping_paidleave__"},{"label":"Disputes between an employee and employer","value":"__dc.disputes_between_an_employee_and_employer_paidleave__"},{"label":"Termination and withdrawal of coverage","value":"__dc.termination_and_withdrawal_of_coverage_paidleave__"}]"
aria-required="false" aria-labelledby="request_custom_fields_7177837999767_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_nxxkct17w" aria-required="false" aria-labelledby="request_custom_fields_7177837999767_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string optional request_custom_fields_7178891194007" hidden="">
<label id="request_custom_fields_7178891194007_label" for="request_custom_fields_7178891194007">Name of organization</label>
<input type="text" name="request[custom_fields][7178891194007]" id="request_custom_fields_7178891194007" aria-required="false" aria-labelledby="request_custom_fields_7178891194007_label" disabled="">
</div>
<div class="form-field string optional request_custom_fields_7178905618071" hidden="">
<label id="request_custom_fields_7178905618071_label" for="request_custom_fields_7178905618071">Preferred dates and times of presentation?</label>
<input type="text" name="request[custom_fields][7178905618071]" id="request_custom_fields_7178905618071" aria-required="false" aria-labelledby="request_custom_fields_7178905618071_label" disabled="">
</div>
<div class="form-field string optional request_custom_fields_7178948742295" hidden="">
<label id="request_custom_fields_7178948742295_label" for="request_custom_fields_7178948742295">Virtual or in-person?</label>
<input type="text" name="request[custom_fields][7178948742295]" id="request_custom_fields_7178948742295" aria-required="false" aria-labelledby="request_custom_fields_7178948742295_label" disabled="">
</div>
<div class="form-field string optional request_custom_fields_7178963520663" hidden="">
<label id="request_custom_fields_7178963520663_label" for="request_custom_fields_7178963520663">How many participants do you expect?</label>
<input type="text" name="request[custom_fields][7178963520663]" id="request_custom_fields_7178963520663" aria-required="false" aria-labelledby="request_custom_fields_7178963520663_label" disabled="">
</div>
<div class="form-field text optional request_custom_fields_7178967268375" hidden="">
<label id="request_custom_fields_7178967268375_label" for="request_custom_fields_7178967268375">Will you need accommodations, such as language interpretation?</label>
<textarea name="request[custom_fields][7178967268375]" id="request_custom_fields_7178967268375" aria-required="false" aria-labelledby="request_custom_fields_7178967268375_label" disabled=""></textarea>
</div>
<div class="form-field string optional request_custom_fields_7175909629335" hidden="">
<label id="request_custom_fields_7175909629335_label" for="request_custom_fields_7175909629335">Assistance grants</label>
<input type="hidden" name="request[custom_fields][7175909629335]" id="request_custom_fields_7175909629335" autocomplete="off"
data-tagger="[{"label":"-","value":""},{"label":"Reporting requirements","value":"__dc.reporting_requirements_paidleave__"},{"label":"Contribution Requirements","value":"__dc.contribution_requirements_paidleave__"},{"label":"Grant amounts","value":"__dc.grant_amounts__"}]"
aria-required="false" aria-labelledby="request_custom_fields_7175909629335_label" value=""
disabled=""><a class="nesty-input" tabindex="0" aria-haspopup="true" aria-expanded="false" aria-controls="_9y8wcdk6m" aria-required="false" aria-labelledby="request_custom_fields_7175909629335_label" style="max-width: 100%;">-</a>
</div>
<div class="form-field string required request_subject">
<label id="request_subject_label" for="request_subject">Subject</label>
<input type="text" name="request[subject]" id="request_subject" maxlength="150" size="150" aria-required="true" aria-labelledby="request_subject_label">
</div>
<div class="suggestion-list" data-hc-class="searchbox" data-hc-suggestion-list="true"></div>
<div class="form-field text required request_description">
<label id="request_description_label" for="request_description">Description</label>
<textarea name="request[description]" id="request_description" aria-required="true" aria-describedby="request_description_hint" aria-labelledby="request_description_label" data-helper="wysiwyg" style="visibility: hidden; display: none;"
aria-hidden="true"></textarea>
<div role="application" id="hc-wysiwyg">
<div role="toolbar"><span aria-haspopup="true" aria-expanded="false"><span role="button" title="Paragraph styles" tabindex="0" class="wysiwyg-icon-formats"></span><span role="menu" aria-hidden="true" tabindex="-1"><span role="button" title=""
tabindex="0" data-block="p" aria-selected="true">Normal text</span><span role="button" title="" tabindex="0" data-block="h2">Header 2</span><span role="button" title="" tabindex="0" data-block="h3">Header 3</span><span role="button"
title="" tabindex="0" data-block="h4">Header 4</span></span></span><span role="button" title="Bold" tabindex="0" class="wysiwyg-icon-bold"></span><span role="button" title="Italic" tabindex="0" class="wysiwyg-icon-italic"></span><span
role="separator"></span><span role="button" title="Bulleted list" tabindex="0" class="wysiwyg-icon-bullist"></span><span role="button" title="Numbered list" tabindex="0" class="wysiwyg-icon-numlist"></span><span
role="separator"></span><span role="button" title="Code block" tabindex="0" class="wysiwyg-icon-code-block"></span><span role="button" title="Insert/Edit link" tabindex="0" class="wysiwyg-icon-link"></span><span role="button" title="Quote"
tabindex="0" class="wysiwyg-icon-quote"></span></div>
<div role="form" aria-expanded="false"></div>
<div role="group"><iframe id="request_description_ifr" frameborder="0" allowtransparency="true" class="tox-edit-area__iframe"></iframe></div>
<div role="alert" aria-hidden="true"></div>
<div><input name="content_type" type="hidden" value="text/html"></div>
</div><input type="hidden" name="request[description_mimetype]" id="request_description_mimetype" value="text/html" style="display: none;" autocomplete="off">
<p id="request_description_hint">(please enter the details of your request. A member of our support staff will respond as soon as possible)</p>
</div>
<script
data-conditional-fields="[{"parent_field_id":"request_custom_fields_7151927599639","value":"employer__i_am_an_employer_representative_paidleave","child_fields":[{"id":"request_custom_fields_7152243398551","is_required":true}]},{"parent_field_id":"request_custom_fields_7151927599639","value":"__dc.other_organization_paidleave__","child_fields":[{"id":"request_custom_fields_7178066039575","is_required":true}]},{"parent_field_id":"request_custom_fields_7151927599639","value":"i_am_self_employed_paidleave","child_fields":[{"id":"request_custom_fields_7177704313623","is_required":true}]},{"parent_field_id":"request_custom_fields_7151927599639","value":"__dc.an_employee_paidleave__","child_fields":[{"id":"request_custom_fields_7177620233495","is_required":true}]},{"parent_field_id":"request_custom_fields_7152243398551","value":"__dc.less_than_25_employees_paidleave__","child_fields":[{"id":"request_custom_fields_7176575994263","is_required":false}]},{"parent_field_id":"request_custom_fields_7152243398551","value":"__dc.25_or_more_employees_paidleave__","child_fields":[{"id":"request_custom_fields_7176663381655","is_required":false}]},{"parent_field_id":"request_custom_fields_7176575994263","value":"__dc.assistance_grants_paid_leave__","child_fields":[{"id":"request_custom_fields_7175909629335","is_required":false}]},{"parent_field_id":"request_custom_fields_7176575994263","value":"__dc.requesting_a_presentation_paidleave__","child_fields":[{"id":"request_custom_fields_7178948742295","is_required":true},{"id":"request_custom_fields_7178963520663","is_required":true},{"id":"request_custom_fields_7178891194007","is_required":true},{"id":"request_custom_fields_7178905618071","is_required":true},{"id":"request_custom_fields_7178967268375","is_required":false}]},{"parent_field_id":"request_custom_fields_7176663381655","value":"__dc.requesting_a_presentation_paidleave__l","child_fields":[{"id":"request_custom_fields_7178963520663","is_required":true},{"id":"request_custom_fields_7178891194007","is_required":true},{"id":"request_custom_fields_7178905618071","is_required":true},{"id":"request_custom_fields_7178948742295","is_required":true},{"id":"request_custom_fields_7178967268375","is_required":false}]},{"parent_field_id":"request_custom_fields_7177620233495","value":"__dc.benefits_paidleave__e","child_fields":[{"id":"request_custom_fields_7177426946583","is_required":false}]},{"parent_field_id":"request_custom_fields_7178066039575","value":"__dc.contribution_rates_paidleave__oo","child_fields":[{"id":"request_custom_fields_7177914687383","is_required":false}]},{"parent_field_id":"request_custom_fields_7178066039575","value":"__dc.requesting_a_presentation_paidleave__oo","child_fields":[{"id":"request_custom_fields_7178891194007","is_required":true},{"id":"request_custom_fields_7178905618071","is_required":true},{"id":"request_custom_fields_7178948742295","is_required":true},{"id":"request_custom_fields_7178963520663","is_required":true},{"id":"request_custom_fields_7178967268375","is_required":false}]},{"parent_field_id":"request_custom_fields_7178066039575","value":"__dc.equivalent_plans_paidleave__","child_fields":[{"id":"request_custom_fields_7177837999767","is_required":false}]},{"parent_field_id":"request_custom_fields_7178066039575","value":"__dc.benefits_paidleave__oo","child_fields":[{"id":"request_custom_fields_7177426946583","is_required":false}]},{"parent_field_id":"request_custom_fields_9413249567127","value":false,"child_fields":[{"id":"request_custom_fields_7151927599639","is_required":true}]}]">
</script>
<div class="form-field">
<label for="request-attachments"> Attachments<span class="optional">(optional)</span>
</label>
<div id="upload-dropzone" class="upload-dropzone">
<input type="file" multiple="true" id="request-attachments" data-fileupload="true" data-dropzone="upload-dropzone" data-error="upload-error" data-create-url="/hc/en-us/request_uploads" data-name="request[attachments][]"
data-pool="request-attachments-pool" data-delete-confirm-msg="" aria-describedby="upload-error">
<span>
<a>Add file</a> or drop files here </span>
</div>
<div id="upload-error" class="notification notification-error notification-inline" style="display: none;">
<span data-upload-error-message=""></span>
</div>
<ul id="request-attachments-pool" class="upload-pool" data-template="upload-template"></ul>
<script type="text/html" id="upload-template">
<li class="upload-item" data-upload-item>
<svg xmlns="http://www.w3.org/2000/svg" width="12" height="12" focusable="false" viewBox="0 0 12 12" aria-hidden="true" class="upload-item-icon">
<path fill="none" stroke="currentColor" stroke-linecap="round" d="M2.5 4v4.5c0 1.7 1.3 3 3 3s3-1.3 3-3v-6c0-1.1-.9-2-2-2s-2 .9-2 2v6c0 .6.4 1 1 1s1-.4 1-1V4" />
</svg>
<div aria-hidden="true" class="upload-item-icon-spacer"></div>
<a class="upload-link" target="_blank" data-upload-link></a>
<p class="upload-path" data-upload-path></p>
<p class="upload-path" data-upload-size></p>
<p data-upload-issue class="notification notification-alert notification-inline" aria-hidden="true"></p>
<span class="upload-remove" aria-label="Remove attachment" role="button" tabindex="0" data-upload-remove>
<svg xmlns="http://www.w3.org/2000/svg" width="12" height="12" focusable="false" viewBox="0 0 12 12" class="upload-item-icon">
<path stroke="currentColor" stroke-linecap="round" d="M3 9l6-6m0 6L3 3" />
</svg>
</span>
<div class="upload-progress" data-upload-progress></div>
<input type="hidden">
</li>
</script>
</div>
<footer><input type="submit" name="commit" value="Submit"></footer>
</form>Text Content
English * English * Español * Pусский * 简体中文 * 繁体中文 * Tiếng Việt Contact Us Frances Online English * English * Español * Pусский * 简体中文 * 繁体中文 * Tiếng Việt * Employers * Overview * What Employers Need to Do * Small Employers * Tribal Governments * Toolkit * Contributions Calculator * Equivalent Plans * Employees * Overview * Applying for Family Leave * Applying for Medical Leave * Applying for Safe Leave * Self-Employed * Overview * How to Choose Paid Leave * Resources * Resources * Common Questions * Forms and Checklists * News and Events * Providers * Sign-in * Search * Frances Online Exit LEAVE THIS SITE QUICKLY BY CLICKING THE EXIT BUTTON. Contact Us Exit 1. Paid Leave Oregon 2. Submit a request Paid Leave Oregon Customer Care Principles When you work with us, here is what you can expect: We put our customers’ privacy and confidentiality first while working with them on the phone, in person, or in writing. We respect our customers’ ability to make their own choices and decisions – they know their lives and experiences the best. We are aware of how our own opinions and beliefs may affect our decisions. We provide clear, easy-to-access communication, and timely responses to customers. We adapt each interaction with our customers to provide service that focuses on their individual needs. We provide our customers peace of mind during life’s most important moments. SUBMIT A REQUEST Have a question about Paid Leave Oregon or want to request a presentation for your employees? Please use this form to submit your questions or to request a presentation. Filling out this form is the fastest way to receive a response to your request. You can also contact us at Paidleave@oregon.gov or by calling 833-854-0166 If you are a member of the news media requesting information on or interviews about Paid Leave Oregon, please email: Communications@employ.oregon.gov Important: this form does NOT work with Internet Explorer. We recommend using a different browser such as Chrome or Safari. We apologize for any inconvenience this may cause. Your email address Name First and Last Name Preferred language None selected Phone Number(optional) Phone Number (ex. 5555555555 (must be a 10 digit number without spaces or dashes)) I do not have a question, I only want to give feedback about Paid Leave Oregon(optional) I am… - Employer size - I have a question about… - I have a question about… - I have a question about… - I have a question about… - I have a question about… - Benefits - Contribution rates - Equivalent plans - Name of organization Preferred dates and times of presentation? Virtual or in-person? How many participants do you expect? Will you need accommodations, such as language interpretation? Assistance grants - Subject Description Normal textHeader 2Header 3Header 4 (please enter the details of your request. A member of our support staff will respond as soon as possible) Attachments(optional) Add file or drop files here -------------------------------------------------------------------------------- ABOUT PAID LEAVE OREGON Paid Leave Oregon is a division of the Oregon Employment Department. HOW WE ARE CREATING PAID LEAVE * Leadership * Rulemaking EQUITY & ACCESSIBILITY PRIVACY POLICY JOIN THE PAID LEAVE TEAM -------------------------------------------------------------------------------- © Copyright Paid Leave Oregon. All Rights Reserved