Extended Leave Checklist Mapping for FMLA, CFRA, FCL, PDL, PPL


FMLA Checklist Item - Activity Code Mapping
Checklist Description  Activity Code Activity Description



Leave Request or more than 3 Days Out Notice? (A) A101 Leave Request Received Send FML1 w/in 5 days (UP)

A102 Absence>3 Days or Info Rcvd: Send FML1 w/in 5 days



Request Clear and Complete? (A) A108 Verified Request Form Clear/Complete



3rd Party Benefit Application? (B) B101 Confirmed SDI/PFL/Insurance Benefit Application

B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check

B109 Verified SDI/PFL/Insurance Checkbox



Supplement with Accrued Time? (B) B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check

B107 EE Requests Full Supplement for SDI/PFL/Insurance

B108 Confirmed EE Partial Supplement Request Amount

B115 EE Will Not Supplement with Accrued Leave



FML1 Notice of Rights Sent? (C) C101 FML1 Hand Delivered - Cert on File (UP)

C102 FML1 Emailed/Mailed - Cert on File (UP)

C103 FML1 Hand Dlvd w/Request for Cert Due 15 Days (UP)

C104 FML1 Email/Mail w/Request for Cert Due 15 Days (UP)



Request Medical/Military/Birth/Placement Cert? (C) C103 FML1 Hand Dlvd w/Request for Cert Due 15 Days (UP)

C104 FML1 Email/Mail w/Request for Cert Due 15 Days (UP)

C106 Medical/Military Cert Received w/Leave Request

C107 FML2/Letter Hand Dlvd, Cert Due 15 Days (UP)

C108 FML2/Letter Mailed/Emailed Cert Due 15 Days (UP)

C109 Req. Confirm of Birth/Place/Adopt Due 15 Days (UP)



Certification Received? (C) C106 Medical/Military Cert Received w/Leave Request

C111 Medical Certificate Received (UP)

C112 Military Exigency Certificate Received (UP)

C113 Military Caregiver Certificate Received (UP)

C115 Bypass Certificate Receipt



Certification Complete and Verified? (D) C115 Bypass Certificate Receipt

D106 Bypass Certificate Verification

D107 Verified Cert Complete Send FML3 w/in 5 days

D111 Authentication Completed Send FML3 w/in 5 days



FML3 Designation Notice Sent? (E) E101 FML3 Designation Notice Sent (UP)

E102 Bypass FML3 Designation Notice



CFRA Checklist Item - Activity Code Mapping
Checklist Description  Activity Code Activity Description



Leave Request or more than 3 Days Out Notice? (A) A101 Leave Request Received Send FML1 w/in 5 days (UP)

A102 Absence>3 Days or Info Rcvd: Send FML1 w/in 5 days



Request Clear and Complete? (A) A108 Verified Request Form Clear/Complete
3rd Party Benefit Application? (B) B101 Confirmed SDI/PFL/Insurance Benefit Application

B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check

B109 Verified SDI/PFL/Insurance Checkbox



Supplement with Accrued Time? (B) B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check

B107 EE Requests Full Supplement for SDI/PFL/Insurance

B115 EE Will Not Supplement with Accrued Leave



FML1 Notice of Rights Sent? (C) C101 FML1 Hand Delivered - Cert on File (UP)

C102 FML1 Emailed/Mailed - Cert on File (UP)

C103 FML1 Hand Dlvd w/Request for Cert Due 15 Days (UP)

C104 FML1 Email/Mail w/Request for Cert Due 15 Days (UP)



Request Medical/Birth/Placement Certification? (C) C103 FML1 Hand Dlvd w/Request for Cert Due 15 Days (UP)

C104 FML1 Email/Mail w/Request for Cert Due 15 Days (UP)

C107 FML2/Letter Hand Dlvd, Cert Due 15 Days (UP)

C108 FML2/Letter Mailed/Emailed Cert Due 15 Days (UP)

C109 Req. Confirm of Birth/Place/Adopt Due 15 Days (UP)

C117 Certification Received w/Leave Request (UP)



Certification Received? (C) C111 Medical Certificate Received (UP)

C115 Bypass Certificate Receipt

C117 Certification Received w/Leave Request (UP)



Certification Complete and Verified? (D) C115 Bypass Certificate Receipt

D106 Bypass Certificate Verification

D107 Verified Cert Complete Send FML3 w/in 5 days

D111 Authentication Completed Send FML3 w/in 5 days



FML3 Designation Notice Sent? (E) E101 FML3 Designation Notice Sent (UP)

E102 Bypass FML3 Designation Notice



FCL Checklist Item - Activity Code Mapping
Checklist Description  Activity Code Activity Description



Leave Request or Other Notice? (A) A110 Leave Request Received (UP)



Request Clear and Complete? (A) A108 Verified Request Form Clear/Complete



3rd Party Benefit Application? (B) B104 Bypass Benefit Application Check

B110 EE Not Eligible or Not Applying For PFL/Insurance

B112 Verified PFL/Insurance Checkbox

B113 Confirmed PFL/Insurance Benefit Application



Supplement with Accrued Time? (B) B104 Bypass Benefit Application Check

B110 EE Not Eligible or Not Applying For PFL/Insurance

B111 EE Requests Full Supplement for PFL/Insurance



Request Medical/Birth/Placement Certification? (C) C109 Req. Confirm of Birth/Place/Adopt Due 15 Days (UP)

C117 Certification Received w/Leave Request (UP)

C118 Hand Delivered Request for Medical Cert (UP)

C119 Emailed/Mailed Request for Medical Cert (UP)



Certification Received? (C) C111 Medical Certificate Received (UP)

C115 Bypass Certificate Receipt

C117 Certification Received w/Leave Request (UP)



Certification Complete and Verified? (D) C115 Bypass Certificate Receipt

D106 Bypass Certificate Verification

D107 Verified Cert Complete Send FML3 w/in 5 days

D111 Authentication Completed Send FML3 w/in 5 days



PDL Checklist Item - Activity Code Mapping
Checklist Description  Activity Code Activity Description



Leave Request or more than 3 Days Out Notice? (A) A101 Leave Request Received Send FML1 w/in 5 days (UP)

A102 Absence>3 Days or Info Rcvd: Send FML1 w/in 5 days



Request Clear and Complete? (A) A108 Verified Request Form Clear/Complete



3rd Party Benefit Application? (B) B101 Confirmed SDI/PFL/Insurance Benefit Application

B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check

B109 Verified SDI/PFL/Insurance Checkbox



Supplement with Accrued Time? (B) B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check

B107 EE Requests Full Supplement for SDI/PFL/Insurance

B115 EE Will Not Supplement with Accrued Leave



FML1 Notice of Rights Sent? (C) C101 FML1 Hand Delivered - Cert on File (UP)

C102 FML1 Emailed/Mailed - Cert on File (UP)

C103 FML1 Hand Dlvd w/Request for Cert Due 15 Days (UP)

C104 FML1 Email/Mail w/Request for Cert Due 15 Days (UP)



Request Medical/Birth Certification? (C) C103 FML1 Hand Dlvd w/Request for Cert Due 15 Days (UP)

C104 FML1 Email/Mail w/Request for Cert Due 15 Days (UP)

C107 FML2/Letter Hand Dlvd, Cert Due 15 Days (UP)

C108 FML2/Letter Mailed/Emailed Cert Due 15 Days (UP)

C109 Req. Confirm of Birth/Place/Adopt Due 15 Days (UP)

C117 Certification Received w/Leave Request (UP)



Certification Received? (C) C111 Medical Certificate Received (UP)

C115 Bypass Certificate Receipt

C117 Certification Received w/Leave Request (UP)



Certification Complete and Verified? (D) D106 Bypass Certificate Verification

D107 Verified Cert Complete Send FML3 w/in 5 days

D111 Authentication Completed Send FML3 w/in 5 days



FML3 Designation Notice Sent? (E) E101 FML3 Designation Notice Sent (UP)

E102 Bypass FML3 Designation Notice



Check Reasonable Accommodation Options? (H) H101 No Reasonable Accommodation Required for RTW

H104 Send RA Request Confirm of Receipt Letter (UP)



PPL Checklist Item - Activity Code Mapping
Checklist Description  Activity Code Activity Description



PPL Authorization Form Received? (A) A105 PPL Authorization Form Received

A106 PPL Acknowledgment Form Received



PPL Election Form Received? (A) A107 PPL Election Form Received



PPL Request Forms Clear and Complete? (A) A108 Verified Request Form Clear/Complete



3rd Party Benefit Application? (B) B101 Confirmed SDI/PFL/Insurance Benefit Application

B103 EE Not Eligible or Not Applying For SDI/PFL/Ins

B104 Bypass Benefit Application Check