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 | |