Get State Disability Insurance Employee Options Checklist - Dpa Ca

Filling out the State Disability Insurance Employee Options Checklist is an important step in managing your disability leave. This guide provides clear, step-by-step instructions to help you complete the checklist accurately and efficiently.

Follow the steps to complete your checklist online.

1. Click the ‘Get Form’ button to obtain the STATE DISABILITY INSURANCE EMPLOYEE OPTIONS CHECKLIST and open it in the online editor.
2. Begin by entering your personal information in the designated fields. This includes your name, CBID, and the last four digits of your social security number. Also, provide your immediate supervisor's name and phone number.
3. Fill out the leave of absence section by entering the beginning and ending dates of your intended leave.
4. Review the list of options available for your leave and select one. If you choose Option A, indicate whether you want to use your leave credits for the seven-day SDI waiting period, and specify the type of leave credits you wish to utilize.
5. If you selected Option B, specify the amount and type of leave credits you wish to use each month while receiving SDI benefits.
6. For Option C, select the leave type you would like to use if you choose not to be on SDI.
7. If you opt for Option D, simply select that you elect to be on a leave of absence without SDI or leave credits.
8. In the health insurance election section, choose whether you would like to maintain your health insurance coverage by selecting yes or no. Initial where indicated to confirm your understanding of your responsibilities regarding health insurance premiums.
9. Sign the checklist and include the date. Place the completed checklist in the provided envelope for submission.
10. If you require further assistance or wish to discuss your options, contact the personnel specialist listed on the form.

Complete your STATE DISABILITY INSURANCE EMPLOYEE OPTIONS CHECKLIST online to ensure your leave is processed smoothly.