Process Forms / Tools How to: Apply for Disability Benefits: Staff - Leaves and Accommodations Faculty - Medical Leave/Pregnancy Leave Post Docs - disability benefits Resident Physicians - disability benefits Apply for Catastrophic Leave: Academic employees Staff employees Change Life Insurance and/or Disability Plan outside Period of Initial Eligibility (PIE) Comply with Family Medical Leave (FMLA) or California Family Rights (CFRA) Request an Ergonomic Evaluation- including ergonomic assessment form For Supervisors Apply for Catastrophic Leave Academic employees Staff employees Catastrophic Leave Donation Form - Academic (.doc) & Staff (.pdf) employees Sample letter to request donation (.pdf) Request form (.pdf) Health Care Provider Certification (.pdf) Disability Packet online Medical Release Forms General (.pdf) - use Reporting Your Disability Claim (see instructions page: Authorization to Release Information) Kaiser (.pdf) - for Kaiser members only Reporting Your Disability Claim Online - Instructions English (.pdf) Spanish (.pdf) Reporting Your Disability Claim - using paper forms Attending Physician's Statement form (.pdf) Employee Disability Claim Form (.pdf) - English Employee Disability Claim Form (.pdf) - Spanish State Disability Income (SDI) application - your date of hire at UCI is less than 18 months. Statement of Health (Evidence of Insurability) (.pdf) Resources Policies and Guidelines About UC Disability Insurance - What to do if? Adopting a Child Having a Baby Breastfeeding and Lactation Support California Family Rights Act (CFRA) CFRA - UCI Guidelines and Procedures Campus Assault Resources & Education (CARE) Catastrophic Leave Program Summary Campus Notification Criteria Donating Time to Catastrophic Leave COBRA - Insurance Continuation (UCNet) Disability / Pregnancy Disability - publications (UCNet) Disability Handbook (UCRP) - (.pdf) Disability and Rehabilitation Services Disability Insurance Premium Estimator Employee-Initiated Reduction In Time Program (ERIT) - UCOP Employee Assistance Program (EAP) - UCI Employment Development Department (EDD) Family and Medical Leave Act (FMLA) Family and Medical Leave Fact Sheet - UCOP (.pdf) FMLA - UCI Guidelines and Procedures Flexible Spending Account (FSA) DepCare and HealthCare FSA - UCNet WEX Benefits - Flexible Spending Accounts Adminstrator Health Insurance Benefits at UCI Health Insurance Portability and Accountability Act (HIPAA) Leaves of Absence Leave Without Pay - UCOP (.pdf) Paid Leave - UCOP Pregnancy Disability Leave (PDL) - Calif. Dept. Fair Employment and Housing (.pdf) Lincoln Financial Group Parenting Workshop Series Wellness website Workers' Compensation menu Academic Personnel - Leave, Medical Separation, Reasonable Accommodation Lactation Accommodation Guidelines UC Policy 84- Accommodations for Nursing Mothers Guidelines Leave Catastrophic Leave - UCI Guidelines Leave of Absence - Policy 2.210 – Absence From Work Leave of Absence - UC Irvine Procedure 43 Sick Leave - Policy 2.210 – Absence From Work Work Incurred Illness and Injury - Policy 2.210 – Absence From Work Work Incurred Illness and Injury - UC Irvine Procedure 44 Medical Separation UC Policy 66 UC Irvine Procedure 66 Reasonable Accommodation UC Policy 81 UC Irvine Procedure 81 Transitional Work Program at UCI Policy Guidelines University Policies and Procedures - UCOP Personnel Policies for UC Staff - UCI Personnel Procedures for UC Irvine Staff Need Help? If you have a question, submit an EEC case, email eec@uci.edu, or call 949.824.0500.

Author: EEC		Last published: 2022-06-09