Show me the money!
What's my name again?
Time Flies
Common Bonds
Potpourri
100

Wage replacement benefits to federal workers and other specific groups who are injured at work

Workers' Compensation

100

Wage replacement benefits for qualified employees

State Disability Insurance (SDI)

100

The unpaid waiting period before a patient is eligible for disability benefits.

7 days

(exception: COVID-19)

100
State Disability Insurance

patient's own illness, injury, pregnancy or childbirth

100

Patient needs time off with money and job protection.

SDI or PFL ($$)

+
FMLA or CFRA (job protection)

200

Filing this form costs $6 each time at official agency.

Temporary disability placard.

200

Federal law that allows eligible employees of covered employers to take unpaid, job-protected leave

FMLA (Family Medical Leave Act)

200

Duration of FMLA

12 work weeks of leave in a 12-month period

200

FMLA

- childbirth, adoption, foster care and care of newborn or newly placed child within 1 year
- employee’s spouse/child/parent who has a serious health condition
- employee's serious health condition
- employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty”

200

Medical exemption for jury duty that does not require physician certification.

Age 70 years or older

(pandemic: age 65 years or older AND high risk for COVID-19 infection)

300

Low cost transportation that must be certified by physician

Access services

Dial-a-Ride

Nonmedical or medical transportation as an insurance benefit (depends on plan)

300

File a report for concern for abuse for a child. 

DCFS (Department of Children and Family Services)

300

Mandated reporters are required to report abuse in this time frame.

Within 24-48 hours

300

Paid Family Leave

- Seriously ill family member
- New child (baby bonding time)
- Family member's military deployment to a foreign country

300

Patient requesting certification for an emotional support animal.

No official form. 

Requires a letter from patient's physician or mental health provider certifying medical need.

400

Purpose of IHSS funds

Hire someone to perform the authorized services, accompaniment to medical appointments, and protective supervision for the mentally impaired)

400

To be eligible for this state program, you must be over 65 years of age, or disabled, or blind.

IHSS (In Home Supportive Services)

400
The number of weeks a patient may request paid family leave.
Up to 8 weeks
400

SSI

Retirement (age 62 & older), Survivor, Disability (includes blindness)

*Provides benefits to eligible family members

400

This form requires dispensing information, prior therapies attempted, and clinical information to be complete.

Prior authorization for medications.

500

Weekly SDI benefit is approximately this much.

60-70% (depending on income) of wages earned 5 to 18 months before claim start date, up to the maximum weekly benefit amount

500

State mandated form to report assault

Suspicious Injury Report

completed form is faxed to police department

500

Length of time someone is disabled before they qualify for permanent disability.

24 months

*exception?

500

SSDI

Age (age 65 and older), Disability (any age, includes children), Blindness (any age, includes children)

* No family benefits

500

Resource for patient's with questions about disability.