Paid leave credit questionnaire · Bridge Tax Credit Partners

1 Company profile

Company name *

Your name *

Your email (for follow-up) *

Phone

Industry

HQ state

1Approximately how many W-2 employees does the company have?

2Does the company have employees in any state with a mandatory paid leave program (CA, CO, CT, DE, MA, ME, MN, NJ, NY, OR, RI, WA, or DC)?

Yes No Unsure

3Are all employees paid out of one legal entity, or multiple entities?

One entity Multiple entities Unsure

2 Leave policy

4Does the company have a written policy that provides paid family and/or medical leave?

Yes No In progress / being drafted Unsure

5Does the company offer paid leave to any employees who are not covered by Family and Medical Leave Act (FMLA) protections (e.g. employees with less than 12 months of service or under 1,250 hours worked, part-time or seasonal staff, or employees at worksites with fewer than 50 employees within 75 miles)?

Yes No Unsure

View non-interference guidance and sample language

If any employee covered by the paid leave policy is not protected by FMLA, the credit requires the written policy to include "non-interference" language and the employer to follow it. The IRS provides model wording (Notice 2018-71, Q&A-3):

"[Employer] will not interfere with, restrain, or deny the exercise of, or the attempt to exercise, any right provided under this policy. [Employer] will not discharge, or in any other manner discriminate against, any individual for opposing any practice prohibited by this policy."

The language can sit in the handbook or in a standalone leave policy, but it has to have been in place during the year being claimed.

3 Workforce & eligibility

6Is paid leave offered to all employees who work at least 20 hours per week and have at least one year of service (or six months, if the policy elects it)?

Yes – all eligible employees Only some employee groups No Unsure

7Roughly what share of employees earn under ~$96,000 per year?

Most Some Few or none Unsure

8Have any employees taken paid family or medical leave in the last 3 years?

Yes No Unsure

4 Tax & records

9Does the company track leave taken (dates, hours, and wages paid during leave)?

Yes No Unsure

10Does the company expect to owe federal income tax for the current year (or did it in the most recent year)?

Yes No Unsure

11Has the company previously claimed the Section 45S Paid Family and Medical Leave Credit?

Yes No Unsure

12Would you like an introduction to a tax credit practice that can review your leave policy, confirm eligibility, and estimate the credit?

Yes No Maybe – would like to discuss first

Additional notes (optional)

Paid family & medical leave credit questionnaire

1 Company profile

2 Leave policy

3 Workforce & eligibility

4 Tax & records