Extended Leaves Checklist Map
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