Section 2706-2 - Claim for Family Temporary Disability Insurance Benefits-Filing and Contents(a) "First claim" means the claim initially filed on a form prescribed by the department with respect to a 12-month period of family care leave. By filing the first claim, the claimant establishes his or her 12-month period and the department computes the weekly benefit amount and maximum benefits potentially payable for the 12-month period.(b) Any individual who has taken time off from his or her work to care for a seriously ill child, spouse, parent, grandparent, grandchild, sibling, registered domestic partner, or to bond with a new child, as they are defined in section 3302 of the code, may file a claim for benefits.(c) A "properly completed first or re-established claim" means a claim containing all the required items as prescribed in subdivisions (d), (e) and (f) of this section.(d) The claimant shall file the first or re-established claim and shall provide his or her: (1) legal name, and any other last name(s) used by the claimant.(2) social security account number, and any other names and social security account numbers by which the claimant is or was known. (A) The department may require the claimant to verify the social security account number as being the one issued to the claimant by the Social Security Administration if the information available to the department indicates that the social security account number presented by the claimant may belong to another individual, is not a valid social security account number, or was never issued by the Social Security Administration, or that the wages in the base period of the claim may belong to another individual.(B) If the department requires verification of the social security account number which the claimant has provided to the department during the claim application, the claimant must submit verification of his or her social security account number directly from the Social Security Administration, or submit to the department a copy of his or her annual statement issued by the Social Security Administration.(6) driver license number or identification card number, provided that the driver license or identification card was issued by a local, state, or federal agency, or a foreign government.(7) last day worked at his or her last job.(8) reason why he or she is no longer working at his or her last job.(10) name(s) and address(es) of his or her most recent employer(s).(11) date on which he or she requests benefits to begin.(12) care or bonding recipient's legal name.(13) relationship to the care recipient. The claimant may be required to provide evidence of the relationship to the family member to support the claim such as a birth or marriage certificate or proof of a registered domestic partnership.(14) statement attesting whether any other family member is ready, willing, able and available to provide care for the same period of time in a day.(16) authorization for the department to disclose the claimant's information as listed herein from (d)(1) to (d)(15) to the care recipient's treating physician or practitioner and to the care recipient.(17) such other information within the scope of eligibility requirements as the department may require.(e) The claimant shall complete the bonding certification if applying for benefits to bond with a new child and shall set forth the new child's:(1) social security account number, if issued. Absence of child's social security account number shall not disqualify the claimant.(2) relationship to the claimant.(3) date of foster care, guardianship, or adoption placement of the new child with the claimant or family member.(8) documentary evidence, pursuant to section 2708(c) - 1 of these regulations.(9) claimant's signature.(10) such other information as the department may require.(f) The claimant shall also provide the information as specified below about the following persons: (1) for a care recipient, the claimant shall provide the care recipient's: (B) social security account number, if issued. Absence of care recipient's social security account number shall not disqualify the claimant.(F) signature or authorized representative's signature authorizing the treating physician or practitioner to release the care recipient's protected health information to the department and the claimant.(2) The claimant shall gather from the treating physician or practitioner on the department's designated form:(A) the name of the care recipient.(B) the date of birth of the care recipient.(C) a diagnosis and diagnostic code(s) prescribed in the International Classification of Diseases, or where no diagnosis has yet been obtained, a detailed statement of symptoms.(D) the date, if known, on which the serious health condition of the care recipient commenced.(E) the probable duration of the care recipient's serious health condition.(F) an estimate of the duration of time that the care provider is needed to care for the care recipient.(G) the number of hours per day that the care provider is needed to care for the care recipient.(H) a statement that the care recipient's serious health condition warrants the participation of the care provider to provide care for the care recipient.(I) a statement regarding whether disclosure of the doctor's certification would be medically or psychologically detrimental to the care recipient.(J) the treating doctor's or practitioner's name and address.(K) the treating doctor's or practitioner's license number.(L) the treating doctor's or practitioner's signature.(M) such other information within the scope of eligibility requirements as the department may require.Cal. Code Regs. Tit. 22, § 2706-2
1. New section filed 6-23-2004; operative 7-1-2004 pursuant to Government Code section 11343.4 (Register 2004, No. 26). For prior history, see Register 69, No. 52.
2. Amendment of subsections (a)-(b) filed 11-6-2008; operative 12-6-2008 (Register 2008, No. 45).
3. Amendment of subsections (c) and (d)(1)-(2), new subsections (d)(2)(A)-(B) and (d)(6), subsection renumbering and amendment of newly designated subsections (d)(16)-(17), (e)(3) and (f)(2)(M) filed 9-16-2011; operative 10-16-2011 (Register 2011, No. 37).
4. Change without regulatory effect amending subsection (b) filed 1-10-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 2).
5. Change without regulatory effect amending subsection (b) filed 12-5-2017 pursuant to section 100, title 1, California Code of Regulations; effective 1-1-2018 (Register 2017, No. 49). Note: Authority cited: Sections 305 and 306, Unemployment Insurance Code. Reference: Sections 2701.5, 2706 and 3303.1, Unemployment Insurance Code.
1. New section filed 6-23-2004; operative 7-1-2004 pursuant to Government Code section 11343.4 (Register 2004, No. 26). For prior history, see Register 69, No. 52.
2. Amendment of subsections (a)-(b) filed 11-6-2008; operative 12-6-2008 (Register 2008, No. 45).
3. Amendment of subsections (c) and (d)(1)-(2), new subsections (d)(2)(A)-(B) and (d)(6), subsection renumbering and amendment of newly designated subsections (d)(16)-(17), (e)(3) and (f)(2)(M) filed 9-16-2011; operative 10-16-2011 (Register 2011, No. 37).2706-7
4. Change without regulatory effect amending subsection (b) filed 1/10/2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 2).
5. Change without regulatory effect amending subsection (b) filed 12-5-2017 pursuant to section 100, title 1, California Code of Regulations; effective 1/1/2018 (Register 2017, No. 49).