Ins5242a 2026

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4.8 out of 5

141 votes

The document is an authorization form for patients to allow medical doctors or nurse practitioners to release medical information necessary for claiming Employment Insurance Family Caregiver Benefits. It outlines the process for signing the form, including provisions for legally authorized representatives if the patient cannot consent. The document also details how the collected information will be used and protected under relevant privacy laws.

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Click ‘Get Form’ to open the ins5242a in the editor.
Begin by filling out the 'Patient Information' section. Enter the last name, given names, date of birth, and home address including apartment number, street number and name, province or territory, city or town, postal or ZIP code, and country.
In the 'Patient's Signature' section, ensure that either the patient or their legally authorized representative signs the form. If a representative is signing, they must also provide their name, relationship to the patient, and phone number.
Review all entered information for accuracy before submitting. Ensure that both the ins5242a form and the Medical Certificate for Employment Insurance Family Caregiver Benefits are completed together.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (141 Votes)
2014	4 Satisfied (33 Votes)

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How can I create an electronic signature on my ins5242a form from Google Chrome?

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Is there a waiting period for compassionate care benefits?

There is a two-week waiting period before you can receive compassionate care benefits. Who is considered a family member under the Employment Insurance Compassionate Care Benefits?

How long is compassionate care leave in Ontario?

Compassionate care leave (unpaid) As an employee, you can take up to 28 weeks of compassionate care leave within a 52-week period to look after a family member who has a serious medical condition with a significant risk of death.

How long is compassionate care in Ontario?

You can receive benefits during the 52 weeks following the date the person is certified by a medical doctor or nurse practitioner to be critically ill or injured or in need of end-of-life care. You can take the weeks of benefits within this timeframe either all at once or in separate periods.

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What is compassionate care benefits in Canada?

Compassionate care benefits (CCB) are Employment Insurance (EI) benefits paid to people who have to be away from work temporarily to provide care or support to a family member who is gravely ill and who has a significant risk of death within 26 weeks (six months).

Can my family come to Canada with me if I am a live in caregiver?

Family members do not normally come to Canada with people working under the Live-in Caregiver Program. Even if an employer agrees that a family member can live with you in the home where you will provide care, future employers may not agree to the same terms.

Who is eligible for Canada caregiver benefit?

The Canada Recovery Caregiving Benefit (CRCB) gave income support to employed and self-employed individuals who were unable to work because they had to care for their child under 12 years old or a family member who needed supervised care.

How long does it take to get EI?

You'll receive your first payment about 28 days after you apply if you're eligible and have provided all required information. If you're not eligible, we'll notify you of the decision made about your application.

How long does it take to get caregiver benefit?

You can expect a decision within eight weeks of submitting a complete application. If approved, your caregiver will begin to receive the benefit within nine weeks and is payable the first day of the month we received your application.