Identifies an employee's periods of disability and the source of compensation when the employee has suffered either (1) job-incurred, (2) non-industrial injury or illness, or (3) a claim for disability status is pending.
Injury/Illness Code = X. See below for coding values.
Injury/Illness Date = MM/DD/YY or blank.
Temporary Disability Date = MM/DD/YY or blank.
Refer to Special Instructions for examples.
If applicabable, enter the date the injury, illness or disability occurred. Leave the date blank if the injury/illness code is 3, 4, or 6.
The Temporary Disability Date is the date the employee is eligible to be placed on TD or IDL benefits, or the date certified by EDD as eligible to receive NDI benefit payments. Leave the date blank if the injury/illness code is 7.
Refer to the Systemwide Human Resources Employee Policies and Programs web page for documentation requirements. Also refer to Special Instructions.
Do not take off payroll; employee has credits for full supplementation. (Item 606 is full month unless there is dock time).
Take off payroll; employee does not have credits for full supplementation OR elected not to supplement (Item 606 is time up to the day before TD).
Returned to work; was on payroll at time of return. (Item 606 is full month unless there is dock time).
Returned to work; was off payroll at time of return (Item 606 is time from the effective date to end of month. If Code 2 or Code 7 is effective in the same pay period, time would be total time due).
Take off payroll; place on IDL status (Item 606 is from the first of the pay period up to the day before IDL).
Returned to work; was off payroll at time of return (Item 606 is from the effective date, through the end of the month, unless Code 5 and Code 6 are effective in the same pay period, total time due).
Take off payroll; employee has used all available leave credits. (1) TPA or EDD reviewing employee's claim for Comp, IDL, or NDI benefits or (2) retirement system is reviewing employee's claim for disability retirement (Item 606 is from the first of the pay period up to the day before pending disability).
Return to Pay Status. Employee returned to work; was off payroll at time of return. Determination by TPA/EDD still pending (Item 606 is from the effective date to the end of the month. If Code 7 and Code 4 are effective in the same pay period, then time is total for the month).
Employee elected to use vacation credits OR campus elected to pay settlement pay to an academic employee.
Employee elected NOT to use vacation OR campus elected not to pay settlement to an academic year employee.
Last Updated: April 14, 2010