California Code of Regulations › Title 22 - Social Security › Division 1 - Employment Development Department › Subdivision 1 - Director of Employment Development › Division 1 - Unemployment and Disability Compensation › Part 2 - Disability Compensation › Chapter 2 - Disability Benefits › Article 4 - Filing, Determination and Payment of Disability Benefit Claims › Section 2706-2 - Claim for Family Temporary Disability Insurance Benefits-Filing and Contents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(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.
(3) date
						  of birth.
(4) gender.
(5) mailing address.
(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.
(9) occupation.
(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.
(15)
						  signature.
(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.