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Department of Human Resources TH 1731 East 120 Street Los Angeles, CA 90059 P: 323.563.5827 F: 323.563.5946 CATASTROPHIC LEAVE PROGRAM LEAVE DONATION FORM Confidential Donors Name Last First MI Job

How to fill out catastrophic leave program

How to fill out catastrophic leave program:

1. Obtain the necessary forms: Start by obtaining the catastrophic leave program forms from your employer or human resources department. These forms typically include an application form and a medical certification form.
2. Read the instructions: Take the time to carefully read through the instructions provided with the forms. Make sure you understand the eligibility criteria, documentation requirements, and any specific procedures or deadlines.
3. Complete the application form: Fill out the application form with accurate and detailed information. Provide your personal details, including your name, employee ID, department, and contact information. Write a brief explanation of the circumstances that led to your need for catastrophic leave.
4. Get medical certification: If the catastrophic leave program requires medical certification, consult with your healthcare provider. They will need to complete the medical certification form, providing details of your medical condition or that of a family member. Ensure the form is filled out accurately and signed by the authorized medical professional.
5. Submit the forms: Once the application form and medical certification form are completed, submit them according to the instructions provided. This may involve submitting them to your supervisor, human resources department, or a designated committee. Follow any additional procedures, such as obtaining signatures or attaching supporting documentation.

Who needs catastrophic leave program?

1. Employees facing a severe medical condition: The catastrophic leave program is designed to assist employees who are facing a severe medical condition that leaves them unable to work for an extended period. This includes individuals with their own medical condition or those needing leave to care for a family member with a serious illness or injury.
2. Those who have exhausted other leave options: The catastrophic leave program is typically a last resort option for employees who have exhausted their regular sick leave, vacation leave, and other applicable leave options. This program provides a way for employees to continue receiving income during their absence, although specific eligibility criteria may vary.
3. Individuals who meet the program's eligibility requirements: Each organization may have its own set of eligibility criteria for the catastrophic leave program. It is essential to review the specific requirements set by your employer to determine if you qualify for this type of leave. Generally, employees must have a demonstrated need for a prolonged leave due to a catastrophic event or medical situation.

For pdfFiller’s FAQs

What is catastrophic leave program?

The catastrophic leave program allows employees to donate unused vacation or sick leave to a designated pool for employees facing a catastrophic illness or injury.

Who is required to file catastrophic leave program?

Employees who are facing a catastrophic illness or injury and have exhausted all paid leave are required to file for the catastrophic leave program.

How to fill out catastrophic leave program?

Employees can fill out the catastrophic leave program application form available from their HR department or online and submit it with supporting documentation.

What is the purpose of catastrophic leave program?

The purpose of the catastrophic leave program is to provide support to employees who are facing a catastrophic illness or injury and have exhausted all paid leave.

What information must be reported on catastrophic leave program?

Employees must report their name, employee ID, nature of illness or injury, estimated hours of leave needed, and any supporting documentation.

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