NYC Health + Hospitals Form SR-70, the “Request for Leave or Approved Absence,” is the single one-page form employees use to request any paid or unpaid time off, from a vacation day to FMLA leave. You download the fillable PDF, complete fields 1 through 11, and hand it to your supervisor, who approves or denies the request and forwards it to the timekeeping office. The form covers annual leave, sick leave, FMLA, compensatory time, NYSNA personal days, other paid absences, and leave without pay.
Where to Get the Form
Download the fillable PDF from the Employee Resources Center’s timekeeping page at nychealthandhospitals.org, listed as “Leave Request Form (SR70).”1NYC Health + Hospitals. Timekeeping Forms, Guides, and Reference Materials You can type into it before printing, or print a blank and complete it by hand. Paper copies are also available from your facility’s timekeeping or human resources office.
Completing the Employee Information Fields
The top of the form (fields 1 through 7) is basic employment data. Work through it before you touch the leave section.2New York City Health + Hospitals. Request for Leave or Approved Absence
- Field 1, Name: print or type your full name as it appears in payroll.
- Field 2, TK ID: your timekeeping ID, which appears on your timesheet directly below your name.
- Field 3, Date of Request: the date you’re filling out the form, not the date of the leave.
- Field 4, Facility or Central Office Division: the hospital, clinic, or division where you work.
- Field 5, Title: your current job title.
- Field 6, Original Date of Appointment (ODA): the date you first started at NYC Health + Hospitals.
- Field 7, Work Location: your cost center or unit name, such as “Telemetry 12 N.”
The TK ID and ODA are the two fields people most often get wrong. If you don’t have your TK ID memorized, pull it off a recent timesheet before you start.
Choosing the Right Leave Type
Field 8 is the heart of the form. Check one box for the type of leave you want, then enter the specific dates, time periods, and total hours. If your absence spans different categories, you may need to submit separate forms.2New York City Health + Hospitals. Request for Leave or Approved Absence
Annual Leave
Use annual leave for vacation, personal business, religious observance, or caring for a sick family member when family sick leave doesn’t apply. Accrual depends on your title and length of service. Check your balance with the timekeeping office before submitting if you’re unsure whether you have enough hours banked.
Sick Leave
Sick leave covers your own illness or medical appointment. You can also use up to three sick days per timekeeping year to care for a family member with supervisory approval; prevailing-rate employees are not eligible for that family-care provision. A physician’s note is required for any sick absence longer than three days.2New York City Health + Hospitals. Request for Leave or Approved Absence
Family and Medical Leave (FMLA)
Check the FMLA box when your absence qualifies under the Family and Medical Leave Act of 1993: birth or adoption of a child, a serious health condition affecting you or an immediate family member, or military family leave. FMLA provides up to 12 weeks of unpaid, job-protected leave per year for employees who have worked at least 12 months and 1,250 hours in the preceding year.3U.S. Department of Labor. Family and Medical Leave (FMLA) When you use the FMLA box, your annual leave, sick leave, or leave without pay is applied under FMLA protections. Medical certification is required.2New York City Health + Hospitals. Request for Leave or Approved Absence
FMLA also requires separate paperwork beyond the SR-70. Use Form 2677 for your own serious health condition and Form 2678 for a family member’s, both available on the Employee Resources Center’s FMLA page.4New York City Health + Hospitals. Family and Medical Leave
Personal Leave Day (NYSNA Members Only)
This box is only for employees in titles covered by the New York State Nurses Association contract, who receive three personal leave days per year. If you’re not in an NYSNA-covered title, skip it.2New York City Health + Hospitals. Request for Leave or Approved Absence
Compensatory Time Off
Use this when you’ve earned comp time for overtime worked and want to take those hours off. The hours must already be credited to your balance.
Other Paid Absence
This catch-all covers jury duty, bereavement leave, separation leave, retirement leave, and floating holidays. If you check this box, specify which category applies in the Remarks section (Field 10).2New York City Health + Hospitals. Request for Leave or Approved Absence
Leave Without Pay
Request LWOP when you’ve exhausted your paid balances and still need time off. Because it affects your paycheck and potentially your benefits, expect closer review from your supervisor.
Purpose of Leave and Remarks
Field 9 asks the reason for your absence. Check one of four boxes: vacation or personal reasons, your own illness or injury, your own medical/dental/optical appointment, or care of a family member. You are not required to describe the nature of an illness — yours or a family member’s — on the form itself.2New York City Health + Hospitals. Request for Leave or Approved Absence If your absence exceeds three days, the physician’s note requirement still applies separately.
Field 10 (Remarks) is where you add clarifying detail. If you checked “Other Paid Absence,” name the type here — jury duty, bereavement, and so on. For other leave types the field is optional.
Signing and Submitting
Sign the form at 11a and date it at 11b, then give it to your supervisor. Your supervisor completes the bottom section: 12a marks whether the request was scheduled in advance or unscheduled, 12b records approval or denial, and 13a and 13b capture the supervisor’s signature and date.2New York City Health + Hospitals. Request for Leave or Approved Absence A “Timekeeping Office Use Only” block at the bottom tracks the debit against your annual or sick leave balance.
Submit planned absences as far in advance as you can. The scheduled/unscheduled distinction the supervisor marks suggests advance planning matters for approval. For an unexpected absence like calling in sick, complete the SR-70 as soon as you return. If you’re out more than three consecutive workdays, contact Human Resources before returning to work.2New York City Health + Hospitals. Request for Leave or Approved Absence
When the SR-70 Is Not the Right Form
Certain absences use other forms entirely, not the SR-70:
- A work-related injury or illness goes on HHC Form 996, not the SR-70. Workers’ compensation absences are handled separately.
- Military leave uses Form SR-71 (Request for Leave of Absence) plus the applicable military certification form.
- FMLA leave still requires the SR-70 box to be checked, but medical certification goes on Form 2677 or Form 2678, submitted separately to HR or Occupational Health.
New York State Paid Family Leave is a separate program with its own application process, not something you initiate through the SR-70. Details on applying through NYC Health + Hospitals are on the Employee Resources Center’s Leaves of Absence page.5New York City Health + Hospitals. Leaves of Absence
Where to Get Help
For questions about your leave balances, accrual rates, or which leave type fits your situation, contact the HRSS Leaves Administration Department at 646-694-6590.5New York City Health + Hospitals. Leaves of Absence You can also check your balances and timesheets through the Employee Self Service portal linked on the Employee Resources Center website.