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MN Earned Sick & Safe

Effective Jan. 1, 2024, Minnesota’s earned sick and safe time law requires employers to provide paid leave to employees who work in the state. For more information, please click on the PDF document.

Please fill out the below form to receive payout of the earned sick and safe time benefit.

Earned Sick & Safe Time PDF

    Employee Information

    Employee Name:

    Employee Number:

    Date of Birth:

    Phone Number:

    Date or Dates Requested:



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