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Unemployment Online

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This page, Self-employed or Statutorily Excluded Employers Request to Opt-in Form, is offered by
Department of Family and Medical Leave

Self-employed or Statutorily Excluded Employers Request to Opt-in Form

If you are a statutorily excluded employer, you will need to fill out this form to notify DFML of your request to opt-in to PFML.

Online Form - Self-employed or Statutorily Excluded Employers Request to Opt-in Form

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