OAR 471-070-1130: Benefits: Verification of Safe Leave

(1) A claimant applying for Paid Leave Oregon benefits for safe leave must provide verification certifying the claimant or the claimant’s child as defined in OAR 471-070-1000 is a survivor of domestic violence, harassment, sexual assault, bias, or stalking. Any of the following documents may be provided as verification: (a) A copy of a federal agency or state, local, or tribal police report, or a formal complaint to a school’s Title IX Coordinator indicating that the claimant or the claimant’s child was a survivor of domestic violence, harassment, sexual assault, bias, or stalking; (b) A copy of a protective order or other evidence from a federal, state, local, or tribal court, administrative agency, school’s Title IX Coordinator, or attorney that the claimant or the claimant’s child appeared in or was preparing for a civil, criminal, or administrative proceeding related to domestic violence, harassment, sexual assault, bias, or stalking; (c) Documentation from an attorney, law enforcement officer, health care provider, licensed mental health professional or counselor, member of the clergy, employee of the Department of Justice division providing victim and survivor services, or victim services provider, verifying that the claimant or the claimant’s child was undergoing treatment or counseling, obtaining services, or relocating as a result of domestic violence, harassment, sexual assault, bias, or stalking; (d) The Paid Leave Oregon Safe Leave Verification Form; or (e) Another document approved by the department for this purpose. (2) The documentation listed in section (1) of this rule must include: (a) The full name of the claimant, or (b) The full name of the child of the claimant, if the claimant is applying for safe leave because the claimant’s child is a survivor of domestic violence, harassment, sexual assault, bias, or stalking. (3) The documentation listed in section (1) of this rule must be dated no more than 12 months before the date the claimant applied for leave. (4) If the documentation is dated earlier than 12 months before the date the claimant applied for leave, the claimant must provide a written statement in addition to documentation listed in section (1) of this rule that describes the current need for leave, along with any additional information requested by the department. (5) In cases where a claimant can demonstrate good cause for not providing one of the forms of documentation in section (1) of this rule, the claimant may instead provide a written statement attesting that they are taking eligible safe leave, which includes a brief description of the purpose for taking leave. Good cause for not providing the documentation is determined at the discretion of the department and includes, but is not limited to, the following: (a) Difficulty obtaining verification due to a lack of access to services; or (b) Concerns for the safety of the claimant or the claimant’s child. (6) If the claimant is applying for safe leave because the claimant’s child is a survivor of domestic violence, harassment, sexual assault, bias, or stalking, and the verification document provided in section (1) of this rule does not show the family relationship between the claimant and the child, the claimant must submit at least one of the following documents that establishes the relationship between the claimant and child; (a) The child’s government issued birth certificate; (b) Court issued documents establishing paternity or guardianship; (c) A Voluntary Acknowledgement of Paternity (form 45-31) signed and witnessed by a hospital representative; (d) The Paid Leave Oregon Verification of Birth Form; (e) One or more documents issued by an independent and verifiable third party that establishes the relationship between the claimant and child; or (f) One or more documents showing that the claimant is in an in loco parentis relationship with the child. The department may consider the following documents alone or in combination to determine whether the claimant has assumed an in loco parentis role with respect to the child: (A) A valid power of attorney granting the claimant authority to care for and make decisions for the child; (B) A court order establishing the claimant as a guardian or custodian of the child; (C) Documentation showing that the claimant has assumed caregiving responsibilities in association with a legal parent’s incarceration; (D) The claimant’s most recent federal or state tax return listing the child as a dependent; (E) A letter from a childcare provider, school, or health care provider identifying the claimant as a primary caregiver for the child; (F) Documentation showing regular financial support to the child; (G) Health insurance documentation listing the child as a covered dependent under the claimant’s policy; and (H) Other documentation approved by the department that demonstrates the nature of the relationship consistent with the factors listed in OAR 471-070-1000. [Publications: Contact the Oregon Employment Department for information about how to obtain a copy of the publication referred to or incorporated by reference in this rule.]