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OFFICE OF SYSTEMS INTEGRATION
REQUEST FOR PROPOSAL OSI 7100-181
UNEMPLOYMENT INSURANCE
MODERNIZATION PROJECT
APPENDIX D – CALL CENTER NETWORK
PLATFORM AND APPLICATION UPGRADE
(CCNPAU) USE CASES
March 23, 2007
ISSUED BY:
STATE OF CALIFORNIA
DEPARTMENT OF GENERAL SERVICES
TECHNOLOGY ACQUISITIONS SECTION
707 3RD STREET, 2ND FLOOR
WEST SACRAMENTO, CA 95605
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Table of Contents
(Appendix D – CCNPAU Use Cases)
D CCNPAU USE CASES ........................................................................................ 5
D.1 INTRODUCTION TO CROSSMATCH ................................................................. 5
D.2 INTRODUCTION TO CCNPAU USE CASES ...................................................... 7
D.3 INTRODUCTION TO USE CASE CONTENT ...................................................... 9
D.4 CCNPAU USE CASES ...................................................................................... 10
D.4.1 Communication and Common Modules .......................................................... 10
D.4.2 UC1 Use Case 0.01 Establish Communications ............................................. 10
D.4.3 UC2 Use Case 0.02 Establish Identity ............................................................ 14
D.4.4 UC4 Use Case 0.04 Queue to Skills-Based Routing ....................................... 17
D.4.5 UC5 Use Case 0.05 EDD Authenticate Identity to UCD .................................. 21
D.4.6 UC67 Use Case 0.06 Send Telephone Number/SSN Information to UCD ...... 23
D.4.7 UC7 Use Case 0.07 Send UI Data Warehouse Information to UCD................ 25
D.4.8 UC8 Use Case 0.08 Receive Data Warehouse Information from UCD ........... 27
D.4.9 UC9 Use Case 0.09 Send SCDB Information to the UCD ............................... 29
D.4.10 UC11 Use Case 0.11 Standard Exceptions .................................................... 31
D.5 CLAIM FILING ................................................................................................... 34
D.5.1 UC17 Use Case 1.02 File Claim ..................................................................... 34
D.5.2 UC23 Use Case 1.08 ID Verification ............................................................... 37
D.5.3 UC24 Use Case 1.09 Complete Claim Filing .................................................. 39
D.5.4 UC14 Use Case 1.012 Clarify Issues .............................................................. 41
D.5.5 UC15 Use Case 1.013 Schedule for Fact-Finding........................................... 43
D.5.6 UC16 Use Case 1.014 Wrap Up: Rights, Responsibilities, and Eligibility
Information ..................................................................................................... 45
D.6 INFORMATION AND QUESTIONS ................................................................... 48
D.6.1 UC25 Use Case 2.01 Main Menu for Information and Questions .................... 48
D.6.2 UC26 Use Case 2.02 Claimant: How Do I Complete This Form? ................... 53
D.6.3 UC27 Use Case 2.03 Claimant: Claim Information ......................................... 57
D.6.4 UC28 Use Case 2.04 Claimant: Inquiries about Determination Interviews ...... 59
D.6.5 UC29 Use Case 2.05 Claimant: Personal Info Change ................................... 63
D.6.6 UC30 Use Case 2.06 Claimant: Inquiries about Payment Status .................... 65
D.6.7 UC32 Use Case 2.08 Claimant: ID Alert Information Calls .............................. 69
D.6.8 UC34 Use Case 2.10 Claimant: Inquiries about Appeals ................................ 72
D.6.9 UC35 Use Case 2.11 Claimant: Inquiries about Overpayments ...................... 74
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D.6.10 UC36 Use Case 2.12 Claimant: Inquiries regarding 1099G Forms ................. 77
D.6.11 UC37 Use Case 2.13 Other: Fraud Reporting ................................................. 83
D.6.12 UC38 Use Case 2.14 Other: Out-System Referral .......................................... 85
D.6.13 UC39 Use Case 2.15 Other: Information on UI Processes .............................. 88
D.6.14 UC41 Use Case 2.31 Employer: Fraud Reporting ........................................... 94
D.6.15 UC42 Use Case 2.32 Employer: Inquiries about Determinations and Appeals 96
D.6.16 UC43 Use Case 2.33 Employer: How Do I Complete This Form? ................... 99
D.7 CONTINUED CLAIMS USE CASES ................................................................ 103
D.7.1 UC44 Use Case 3.0 Continued Claims: Pre-Screening................................. 103
D.7.2 UC45 Use Case 3.1 Continued Claims: Determine Weeks ........................... 105
D.7.3 UC46 Use Case 3.2 Continued Claims: Capture Eligibility ............................ 108
D.7.4 UC47 Use Case 3.3 Continued Claims: Able ................................................ 111
D.7.5 UC48 Use Case 3.4 Continued Claims: Available ......................................... 113
D.7.6 UC49 Use Case 3.5 Continued Claims: Efforts to Seek Work ....................... 115
D.7.7 UC50 Use Case 3.6 Continued Claims: Refused Suitable Work ................... 117
D.7.8 UC51 Use Case 3.7 Continued Claims: Began Training ............................... 119
D.7.9 UC52 Use Case 3.8 Continued Claims: Submission ..................................... 121
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Table of Tables
(Appendix D – CCNPAU Use Cases)
TABLE 1 – USE CASE AND FLOW REFERENCE CROSSMATCH .....................................5
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D CCNPAU USE CASES
D.1 Introduction to Crossmatch
The following table was created by the Employment Development Department as
a cross-reference between the CCNPAU Use Cases (Appendix D) and the
CCNPAU Process Flow Diagram (Appendix G). Use Case refers to the Use Case
number in Appendix D. Use Case Name refers to the Use Case Name in
Appendix D. Flow Ref refers to the reference number in the header on each
page in Appendix G. Process Flow Name refers to the Process Flow Name in
the header on each page in Appendix G. Telephone Tree Level refers to the flow
level in the header on each page in Appendix G.
Table 1 – Use Case and Flow Reference Crossmatch
CROSSMATCH OF UI FUNCTIONAL REQUIREMENTS FLOW (APPENDIX G) TO USE CASES
(APPENDIX D)
USE USE CASE NAME FLOW PROCESS FLOW NAME TELE-
CASE REF PHONE
TREE
LEVEL
0.01 Establish Communications B-1 Initial Contact/Establish 1
Communications
0.02 Establish Identity B-1 Initial Contact/Establish 2
Communications
B-2 Claim Filing 2
0.04 Queue to Skills-Based Routing B-1 Initial Contact/Establish 1
Communications
B-2 Claim Filing
B-5 Information and Questions 3
B-6 Information and Questions 3
B-7 Information and Questions 3
B-7.1 Information and Questions 3
B-8 Information and Questions 3
B-9 Information and Questions 3
B-10 Information and Questions 3
B-11 Information and Questions 3
B-12 Information and Questions 3
B-16 Information and Questions 3
B-17 Information and Questions 3
B-18 Skills-Based Routing 3
0.06 Send Telephone Number/SSN B-2 Claim Filing 2
Information to UCD
B-6 Information and Questions 3
B-7 Information and Questions 3
B-11 Information and Questions 3
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CROSSMATCH OF UI FUNCTIONAL REQUIREMENTS FLOW (APPENDIX G) TO USE CASES
(APPENDIX D)
0.07 Send Client Registry Information to B-19 System Exit 3
UCD
0.08 Receive Client Registry Information B-19 System Exit 3
from UCD
1.02 File Claim B-2 Claim Filing 2
1.014 Wrap Up: Eligibility Information B-2 Claim Filing 2
2.01 Main Menu for Information and B-3 Information and Questions 3
Questions
B-4 Information and Questions cont’d 3
2.02 Claimant: How Do I Complete this B-5 Information and Questions 3
Form?
2.03 Claimant: Claim Information B-4 Information and Questions 3
2.04 Claimant: Inquiries about B-7 Information and Questions 3
Determinations Interview
2.06 Claimant: Inquiries about Payment B-6 Information and Questions 3
Status
B-8 Information and Questions 3
2.08 Claimant: ID Alert Information Calls B-8 Information and Questions 3
2.10 Claimant: Inquiries about Appeals B-9 Information and Questions 3
2.11 Claimant: Inquiries about B-10 Information and Questions 3
Overpayments
2.12 Claimant: Inquiries about B-11 Information and Questions 3
Overpayments
B-12 Information and Questions 3
B-13 Information and Questions 3
2.13 Fraud Reporting B-17 Information and Questions 3
2.14 System Referral B-17 Information and Questions 3
2.15 Information on UI Processes B-14 Information and Questions 3
B-15 Information and Questions 3
2.31 Employer: Fraud Reporting B-17 Information and Questions 3
B-16 Information and Questions
2.32 Employer: Inquires about B-16 Information and Questions 3
Determinations and Appeals
2.33 Employer: How Do I Complete this B-5 Information and Questions 3
Form?
0.30 Pre-Screening B-20 Certify for Benefits 4
03.1 Determine Weeks B-20 Certify for Benefits 4
03.2 Capture Eligibility B-21 Certify for Benefits 4
03.3 Able B-21 Certify for Benefits 4
03.4 Available B-21 Certify for Benefits 4
03.5 Effort to Seek Work B-21 Certify for Benefits 4
03.6 Refused Suitable Work B-22 Certify for Benefits 4
03.7 Began Training B-22 Certify for Benefits 4
03.8 Submission B-22 Certify for Benefits 4
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D.2 Introduction to CCNPAU Use Cases
The Employment Development Department (EDD) – Unemployment Insurance
Division has chosen ―Use Cases‖ as the means for expressing its detailed
requirements for the Call Center Network Platform and Application Upgrade
(CCNPAU). These requirements are for a Unified Call Distribution (UCD) system
that encompasses both an interactive voice response (IVR) component and an
intelligent call manager (ICM) component—as a single application that provides
caller services for the Department’s operations.
A Use Case is a scenario that uses business language to describe the
interactions between those that use the UCD and the UCD itself. It includes
goals, business rules, exceptions, and any issues that must be addressed during
the Detailed Design Phase of the CCNPAU project. The Use Cases are
requirements that provide a framework for the Detailed Design—not the Detail
Design and Specifications themselves.
Use Cases are not design documents. Rather, they reflect detailed requirements
for the UCD. The Integration Contractor for the CCNPAU project will be
expected to develop a Detailed Design Document based on these requirements.
The ―Conversational Mode‖ has been selected as the means for displaying the
Use Case bodies. Here an Actor (a Department staff person, a caller, or an
auxiliary system) interacts with the UCD in a dialog. The following conventions
are used throughout the Detailed Requirements to consistently formulate specific
actions in the Use Cases.
[NOTE 1: There will be revision to the Use Cases after Skills-Based Routing has
been defined; i.e., additional NAVFLAGS will be added so that the UCD knows
where to route the calls.]
Actor System
ENTERS: Actor enters an option in response PROMPT: The UCD states a prompt sentence
to a system prompt or menu. or question that requires a single response
from the Actor.
SELECTS: Actor selects a response to a PRESENTS MENU: The UCD states options
request from the system. from which the Actor selects a response.
IF: A conditional statement based on Actor
selection. Condition is always indented under
the IF statement.
READS: In response to a selection by the
Actor, the system presents a prerecorded piece
of information.
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Actor System
SPEAKS: In response to an Actor input and/or
data look-up, the system presents a
customized message.
GOTO: The system is redirected to another
Use Case.
SAVES INFORMATION: The system saves
collected information to a file or database.
GOTO: 0.04 QUEUE TO SKILLS- BASED
ROUTING: The UCD directs the call to a staff
person based on a skills and priority routing
table.
GOTO: OUTSIDE TRANSFER: The caller is
transferred outside the UCD.
SET NAVFLAG: The UCD sets a parameter
for use in Skills-Based Routing.
SET DATA FLAG: The UCD sets a parameter
to identify data that must be provided to or from
an interface.
LOOK-UP: The UCD references an external
system or internal file to collect information
regarding the call.
STORE: Information regarding the call, the
claim, and/or the information collected is saved
in the UCD reporting database as well as an
external data store.
In general, EDD desires that the UCD operate these Use Cases using the
following general rules:
There will be no more than five (5) selections on a presented menu.
At any prompt, there will be no more than three (3) sub-layers or
submenus.
The requests for input must be presented such that the caller can
respond using numbers only on a touch tone phone.
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D.3 Introduction to Use Case Content
The Detailed Requirements are divided into four areas depending on the type of
call and the type of service or information that the caller is expecting to receive.
A general picture of these areas is provided in the Use Case Diagrams included
as Appendix A to this document.
For each area, there is a general description of the goals, services, and
information requirements. This is followed by the Use Cases in that area. A
narrative explanation is provided at the beginning of each Use Case. A Process
Flow Diagram that shows the linear progress of the functionality of the UCD is
included as Appendix G to the RFP.
The four areas are:
D.4.1 Communication and Common Modules—An area in which the UCD
establishes contact with the caller. Also, this area includes Use Cases
that are included in more than one domain.
D.5 Claim Filing—A service related domain for callers who wish to establish
an Unemployment Insurance Claim.
D.6 Information and Questions—A place that callers can go for information
about the Unemployment Insurance Program.
D.7 Claim Certification—A domain in which callers who have already filed for
Unemployment Insurance benefits certify their continuing eligibility for
benefits.
Many Use Cases require that callers be referred to a queue in which they wait for
an available interviewer. The UCD uses a Skills-Based Routing Table to
establish to whom calls should be referred. Referrals are made on two bases:
1. The staff person has the skills necessary to respond to the service or
information needs of the caller;
2. A priority order has been established based on the service demands and
staff available to respond to those demands (Note: Prioritization is
dynamically managed on a day-to-day basis).
A preliminary definition of Skills is included in Appendix C: Skills Definition Matrix.
Appendix D: Skills-Based Routing Matrix shows what Use Cases use which
skills.
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D.4 CCNPAU Use Cases
D.4.1 Communication and Common Modules
All callers seeking to file a new, additional, or reopened Claims, to certify
eligibility for claim benefits, or to receive information regarding the
Unemployment Insurance program, must first establish communication with the
UCD using a touch tone telephone. The first Use Case describes user
interaction that establishes communication.
D.4.2 UC1 Use Case 0.01 Establish Communications
Use Case Number
0.01
Use Case Name:
Establish Communication
Goal:
Establish Communication with the caller.
The Preamble
Actor Name:
Caller
Stakeholders and Interests:
Client Advocacy Groups: Assure that special and protected groups receive parity
of service; i.e., that special groups are able to file claims, certify for benefits, and
receive information regarding the UI program.
EDD: Comply with state law for access to services.
Context:
Establish Communication
Preconditions:
Telephone
Success Guarantee:
Claimant successfully communicates with EDD to receive services or information.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
Caller telephones 800 numbers for STORE: Automatic Number Identification
Vietnamese, Cantonese, or Mandarin. (ANI) for the phone number from which the
call is made
IF Vietnamese:
SET NAVFLAG = Vietnamese
READS: Statement of
authenticity of information
provided.
PROMPT: Enter SSN
STORE: SSN and ANI in database
GOTO: 0.04 Queue for Skills-Based
Routing/Vietnamese
IF Cantonese:
SET NAVFLAG = Cantonese
READS: Statement of
authenticity of information
provided.
PROMPT: Enter SSN
STORE: SSN and ANI in database
GOTO: 0.04 Queue for Skills-Based
Routing/Cantonese
IF Mandarin:
SET NAVFLAG = Mandarin
READS: Statement of
authenticity of information
provided.
PROMPT: Enter SSN
STORE: SSN and ANI in database
GOTO: 0.04 Queue for Skills-Based
Routing/Mandarin
STORE: Automatic Number Identification
(ANI) for the phone number from which the
call is made
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Actor’s Actions (Claimant) System Responses (UCD)
Caller telephones 800 number for
Spanish/English PRESENT MENU:
1. English
2. Spanish
SELECTS: English or Spanish IF No Selection Made or No Response
Touch Tone Fail (TTF)
GOTO: 0.04 Queue for Skills-Based
Routing
IF English:
SET NAVFLAG = English
PRESENT MENU:
1. File Claim
2. Certify for Benefits
SELECTS: A response 3. Information and Questions
IF Spanish:
SET NAVFLAG = Spanish
PRESENT MENU:
1. File Claim
2. Certify for Benefits
SELECTS: A response 3. Information and Questions
IF File Claim:
GOTO: 0.02 Establish Identity
IF Certify for Benefits:
GOTO: 3.0
IF Information and Questions:
GOTO: 2.0
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Supplementary Details and Constraints
Alternative Flows (Variations):
There are several alternatives available to EDD regarding how customers choose their
language preference:
1. Callers may choose languages using separate 800 numbers for each language
rather than using a UCD menu.
2. Callers may choose languages using separate 800 numbers for languages
other than English or Spanish and use UCD to select for English or Spanish.
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
The EDD needs to make a policy decision whether language selection is accomplished
through the UCD, the 800 numbers for each language, or a combination of the two.
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D.4.3 UC2 Use Case 0.02 Establish Identity
This Use Case is used in the Information and Questions process whenever a
Claimant needs information regarding the payment status of the claim or to find
out when a determination interview is scheduled, and is used when a Claimant
wishes to certify their continuing eligibility for benefits. In addition to establishing
identity, all Social Security Numbers and ANIs are stored to a database. All
information is used for decision support (claimant trends) and suspect Social
Security Numbers and ANIs are tagged for potential misrepresentation.
Use Case Number
0.02
Use Case Name:
Establish Identity
Goal:
Collect information from the caller that can later be used for verification of identity and
reporting purposes.
The Preamble
Actor Name:
Caller
Stakeholders and Interests:
Employers/Employer Agents: Ensure benefits are paid to appropriate Claimants and
that benefit charges are correct.
Elected Officials: Protect the public interest.
EDD: Protect fiduciary responsibility to owner of the identity, avoid liability, and
prevent fraud and establish information database regarding Social Security Numbers
and ANIs.
Department of Labor: Enforce compliance with Federal laws and regulations.
Context:
Client Specific UI Information and Questions
Certify for Benefits
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Preconditions:
0.01 Establish Communications
Success Guarantee:
UCD collects information from Claimant that can be used for identification.
Use Case Body
Actor’s Actions (Caller) System Responses (UCD)
READS: Statement on authenticity of
information provided
PROMPT: Enter SSN
ENTERS: SSN
STORE: SSN with ANI for number from
which the call is made
IF Certify for Benefits
ENTERS: PIN PROMPT: Enter PIN
IF Requesting Payment Status of Claim:
PROMPT: Enter PIN
ENTERS: PIN
IF Requesting date and time of
determination appointment:
PROMPT: Enter PIN
ENTERS: PIN
LOOK-UP: The UCD looks up PIN system to
match SSN and PIN
IF No PIN Match:
GOTO: PIN IVR, see design
consideration below
IF PIN Match:
GOTO:
2.04 Claimant Inquires
about Determinations Interviews
2.06 Claimant:
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Inquiries about
Payment Status
3.0 Continued Claims
Supplementary Details and Constraints
Alternative Flows (Variations):
For callers whose primary language is not English or Spanish, identification information
will be taken by a CSR.
Special Requirements:
UCD must have the capability of acquiring and storing the ANI.
Exceptions:
Exception or Error Recovery Action Effect on User
PIN System
System cannot verify SSN System gives caller second Caller must provide an SSN
provided by caller chance to enter SSN that is on EDD file.
If not, caller is queued to
agent through Skills-
Based Routing.
System cannot verify PIN System gives caller second Caller must provide a PIN
provided by caller chance to enter PIN that is valid. If not, caller is
queued to agent through
Skills-Based Routing
Caller fails to enter SSN or Disconnect Caller must provide an SSN
PIN after two attempts or a PIN
Technology and Data Variations List:
Social Security Number = ―XXX-XX-XXXX‖
Automatic Number Identification = ―XXX.XXX.XXXX‖
PIN = Unknown
Frequency of Occurrence:
Design Considerations: Currently Claimants can change their PIN in the IVR if they forgot
their PIN. The IVR prompts them for identifying information and if they are unable to enter the
identifiers correctly they are transferred to an agent. This may change during design.
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D.4.4 UC4 Use Case 0.04 Queue to Skills-Based Routing
Callers are routed from various scenarios to a queue waiting for the next
available staff person who has the skills to respond to the service need or the
information question.
Use Case Number
0.04
Use Case Name:
Queue to Skills-Based Routing
Goal:
Route the caller to staff person with skills to respond and with shortest wait time, state-
wide. Logic in the Queue must be flexible enough to handle overflow routing.
The Preamble
Actor Name:
Claimant
CSR
Employer
Other
Stakeholders and Interests:
EDD: Ensure that all calls are answered within waiting-time limits.
Context:
Claim Filing
Information and Questions
Preconditions:
IF Claim Filing:
0.01 Select Claim Filing Service
IF Information and Questions:
2.02 Claimant: How Do I Complete this Form?
2.04 Claimant: Inquiries about Determinations Interview
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2.05 Claimant: Personal Information Change
2.06 Claimant: Inquiries about Payment Status
2.08 Claimant: ID Alert Information Calls
2.10 Claimant: Inquiries about Appeals
2.11 Claimant: Inquiries about Overpayments
2.12 Claimant: Inquiries about 1099
2.13 Other: Fraud Reporting
2.32 Employer: Inquires about Determinations and Appeals
Success Guarantee:
The caller is routed to a staff person with skills to respond in the shortest wait time. The
UCD handles overflow routing when necessary.
Use Case Body
Actor’s Actions System Responses
IF Call Arrives Outside Normal Business
Hours:
READS: Message regarding normal
business hours
OTHERWISE: Proceed
IF Caller Comes from Claim Filing:
READS: Claimant Rights and
Responsibilities
READS: Process and waiting time
REPEATS UNTIL: (Every X minutes) Queue
message until staff person is available
Reviews NAVFLAGS from UCD activities
LOOK-UP: Available Agent with skills to
respond to services or provide information in
SKILLS-BASED ROUTING TABLE (See
Appendices C and D)
ROUTE: Call to next available agent
IF Call Terminates Early:
Store call information, not data
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Actor’s Actions System Responses
collected from caller, to UCD Reports
System as well as external data store
IF Claim Filing:
GOTO: Available Agent with skills to claim
filing SKILLS-BASED ROUTING TABLE (See
Appendices C and D)
ROUTE: to next available agent
IF Information and Questions:
LOOK-UP: Available Agent with skills to
respond to services or provide information
in SKILLS-BASED ROUTING TABLE (See
Appendices C and D)
ROUTE: to next available agent
Supplementary Details and Constraints
Alternative Flows (Variations):
System has capability to call back Claimant after queue wait times are reduced or
terminates the call with a message.
Rights and Responsibilities may alternatively be included in Use Case 1.014: Wrap-up.
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
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Design Considerations:
There is a need to review information retention when the caller terminates the call
prematurely. (This may impact the ID Alert Program).
Decision needs to be made regarding whether a Claimant is required to enter a keystroke
affirming that he/she has heard the Rights and Responsibilities Statement. EDD will not
have caller affirm that he/she heard the Rights and Responsibilities Statement. EDD to
determine where the statement will be during design.
Rights and Responsibilities can be read to the caller when they select
Claim Filing.
At each point where the caller is queued to skills-based routing, the system will have to
look and see if the call is within or outside regular business hours. If within business
hours, then queue the call, if outside business hours UCD reads that the caller must call
back during regular business hours.
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D.4.5 UC5 Use Case 0.05 EDD Authenticate Identity to UCD
Before EDD staff can respond to caller’s service and information requests they
must be identified by the UCD and their identity associated with the Skills-Based
Routing Table so that calls may be referred.
Use Case Number
0.05
Use Case Name:
EDD Authenticate Identity to UCD
Goal:
Cause EDD staff to sign-on to the call UCD with the appropriate rights and privileges
needed to provide services and respond to information requests; i.e., to allow the EDD
staff to use the system.
The Preamble
Actor Name:
EDD Staff
Stakeholders and Interests:
EDD: Make sure that the right staff is available to do the work, manage the staff and
the workload and fulfill its global security responsibility.
Context:
Claim Filing
Information and Questions
Certify for Benefits
Preconditions:
The CSR must have access to computer and/or telephone.
Success Guarantee:
The EDD staff has appropriate access to the system and can provide services to the
public.
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Use Case Body
Actor’s Actions System Responses
PROMPT: Enter user ID and password
ENTERS: user ID and password
Authenticates user ID and password against
database
Connects staff to Skills-Based Routing system
Is successfully logged into the system
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Desirable: Single sign-on for telephone system and benefits system.
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
User ID – Format to be determined
Password – Format to be determined
Frequency of Occurrence:
Design Considerations:
The type of sign-on may be determined by the desktop appliance that is used with the
UCD; i.e., whether EDD invests in ―smart-phones‖ (a single appliance could act as a
computer and telephone with a single sign-on of access to all systems used.) ―Smart
Phone‖ availability can be accomplished by adding sound cards to the personal
computers or at upgrading personal computers at the time of normal computer
replacement.
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D.4.6 UC67 Use Case 0.06 Send Telephone Number/SSN
Information to UCD
This Use Case describes how the Telephone Number/Social Security Number
database provides information to the UCD for use in identifying potential identity
misrepresentation.
Use Case Number
0.06
Use Case Name:
Send Telephone Number/SSN Information to UCD.
Goal:
Provide information on potential fraud due to misuse of SSN or often used telephone
numbers.
The Preamble
Actor Name:
Telephone/SSN Database
Stakeholders and Interests:
EDD: To provide database of SSNs and ANIs, and to provide information to assist in
identifying misrepresentation early in the claim process.
Context:
Claim Filing
Certify for Benefits
Information and Questions/Claimant
Preconditions:
ANI captured from caller
Claimant enters SSN
.
Success Guarantee:
SSN and ANI are written to the SSN/ANI database
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Use Case Body
Actor’s Actions System Responses
RECEIVES: SSN and ANI from UCD
WRITES: SSN and ANI to SSN/ANI database
GOTO: 1.08 ID Verification
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Database must be populated.
Exceptions:
Exception or Error Recovery Action Effect on User
If SCDB Not Available GOTO: 1.11 Standard Claim may be taken on
Exceptions paper.
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
The SSN/ANI Database is a new database. This database must be created as part of
this project.
During design, the process for using this database to identify misrepresentations needs
to occur.
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D.4.7 UC7 Use Case 0.07 Send UI Data Warehouse Information to
UCD
Respond to queries from the UCD with information retained in the UI Data
Warehouse. The UI Data Warehouse may not be built prior to CCNPAU
implementation phases.
Use Case Number
0.07
Use Case Name:
Send UI Data Warehouse Information to UCD.
Goal:
Provide information to the UCD (from the UI Data Warehouse) for use in providing
services or responding to requests for information.
The Preamble
Actor Name:
UI Data Warehouse
Stakeholders and Interests:
The CSR: Needs information to successfully complete the claim or respond to a
request for information.
Context:
Claim Filing
Information and Questions
Certify for Benefits
Preconditions:
UCD queries data warehouse for information from Claim Filing or Information and
Questions.
Success Guarantee:
UI Data Warehouse provides information to other systems as requested.
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Use Case Body
Actor’s Actions (UI Data Warehouse) System Responses (UCD)
UCD: Requests information from UI Data
Provides information that is requested. Warehouse.
The CSR: requests information from UI Data
Provides information that is requested. Warehouse.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
The CCR Project must create the UI Data Warehouse.
The UCD must provide the data storage until the UD Data Warehouse is built.
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.4.8 UC8 Use Case 0.08 Receive Data Warehouse Information
from UCD
The UI Data Warehouse is a data mart that contains information used for
reporting and decision support. The reporting and decision support processes
require information from the UCD to populate the UI Data Warehouse database.
The UI Data Warehouse may not be built prior to CCNPAU implementation
phases.
Use Case Number
0.08
Use Case Name:
Receive UI Data Warehouse Information from UCD.
Goal:
Store information to provide MIS reports and decision support.
The Preamble
Actor Name:
UI Data Warehouse
Stakeholders and Interests:
EDD: Use information and reports to manage the Unemployment Insurance System.
Context:
Claim Filing
Information and Questions
Certify for Benefits
Preconditions:
At the end of each call and procedure, call and Claimant specific information is sent to
the UI Data Warehouse.
Success Guarantee:
Information successfully transferred and retained in the UI Data Warehouse.
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Use Case Body
Actor’s Actions (UI Data Warehouse) System Responses (UCD)
Stores information in a database. Sends information to the UI Data Warehouse.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
UI Data Warehouse must be redundant (servers and locations) so that no information is
lost.
Exceptions:
Exception or Error Recovery Action Effect on User
None
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.4.9 UC9 Use Case 0.09 Send SCDB Information to the UCD
The SCDB is the Benefits Payment system. The UCD will make queries of
SCDB especially in response to caller requests to certify for benefits.
Use Case Number
0.09
Use Case Name:
Send SCDB Information to the UCD.
Goal:
Provide information to the UCD for use in providing services and responding to
requests for information.
The Preamble
Actor Name:
SCDB
Stakeholders and Interests:
Claimants: Need information to successfully certify for benefits.
Context:
Information and Questions
Certify for Benefits
Preconditions:
UCD queries SCDB (or file) for Claim Filing or Information and Questions information.
Success Guarantee:
Information is provided to the UCD for use by claimant to certify for benefits.
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Use Case Body
Actor’s Actions (SCDB) System Responses (UCD)
SCDB provides information. Requests information from SCDB.
Claimant responds to information from SCDB. UCD provides SCDB information
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
None
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
An Output Interface with SCDB is required for all interactions. This Interface may be
built by the Integration Contractor as part of the CCNPAU project or by EDD staff for
later implementation. If the CCNPAU contractor is to build the Interface, this needs to
be included as a system requirement.
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D.4.10 UC11 Use Case 0.11 Standard Exceptions
The UCD must capture errors and redirect callers when errors occur during input
on a touch-tone phone. In addition, the final design will need to account for
situations in which part of the system may not be operating, either regionally or
statewide. If the UCD is down, or a portion of it, it is mandatory that calls be
redirected to agents based on a default routing table if this occurs during
business hours. For example: if Skills-Based Routing functionality is not
available, the IVR uses default tables to route the calls to agents.
Use Case Number
0.11
Use Case Name:
Standard Exceptions
Goal:
Handle exceptions when errors occur in input or systems are not available.
The Preamble
Actor Name:
CSR
Employer
Other
Stakeholders and Interests:
Callers need information if system is down.
The EDD needs to provide information and services to the public when there is an
interruption of service.
Context:
Claim Filing
Information and Questions
Certify for Benefits
Preconditions:
All use cases.
Success Guarantee:
The UCD handles errors in input with the result that the services to the caller are
uninterrupted.
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Use Case Body
Actor’s Actions System Responses (UCD)
IF Valid Entry Not Made:
The UCD returns Actor to previous
menu or prompt
Repeat ―2‖ times on repeated failure
READS: Message
Disconnect from system
IF Caller Made an Incorrect Menu
Selection:
PRESENTS MENU: menu selections
should be within the call process of
the use case to allow the caller to exit,
to go back to Previous Prompt or
menu, or return to main menu
IF Caller Terminates Call Early:
GOTO: 0.08 Receive UI Data
Warehouse Information from UCD
IF UI Data Warehouse Not Available:
(Needed for Input)
GOTO: Next Step in Use Case
IF UI Data Warehouse Not Available:
(Needed for Output)
The UCD retains information in a
temporary file and transfers to UI
Data Warehouse for batch processing
at a later time or for later inquiry
IF SCDB Not Available: (Claim Filing)
The UCD Displays information
CSR files claim on paper
IF UCD Not Available to a Center or
Region:
The UCD Redirects calls to available
Call Centers until regional availability
is restored
IF the IVR Portion on UCD is Not Available:
(Claim Filing)
Calls are redirected to agents based
on a default routing table so that calls
can route outside the call routing
portion of the UCD. The CSR takes
Claim in SCDB.
IF UCD Not Available: (Information and
Questions)
Calls are redirected to agents based
on a default routing table.
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Actor’s Actions System Responses (UCD)
IF UCD Not Available: (Certify for Benefits)
Caller receives a custom message.
IF UCD and SCDB Not Available: (Claim
Filing)
Calls are redirected to agents based
on a default routing table. Claims are
taken on paper.
IF UCD and SCDB Not Available:
(Information and Questions)
Calls are redirected to agents based
on a default routing table.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
None
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
1. EDD needs to establish procedures for responding to technical emergencies.
2. EDD needs to make a policy decision defining the circumstances under which a
caller is disconnected from the system; e.g., two failed attempts to make valid entry
causes disconnect. Design consideration: where does this occur within verification and
certification, or does the caller get transferred to an agent?
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D.5 Claim Filing
The primary business of the Unemployment Insurance Division is to receive,
validate and pay Unemployment Insurance Benefits. The Use Cases in this
section gather information through the UCD and routes the call to the next
available agent with the skills to assist the caller for completion of the Claim
Filing Process.
D.5.1 UC17 Use Case 1.02 File Claim
Prospective UI Claimants will be asked by the UCD to provide basic claim
information that can be input using a telephone keypad. This information will be
used with the information gathered by the CSR to file a new UI Claim.
Use Case Number
1.02
Use Case Name:
File New Claim
Goal:
Caller provides designated information for filing a new UI Claim.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
Employers: Ensure that charges against their tax rate accounts are appropriate. If
last employer, the employer is responsible for eligibility.
EDD – Ensure that the Claimant is legally entitled to receive benefits and that
payments are made consistent with EDD and Department of Labor regulations.
Context:
Claim Filing
Certify for Benefits
Information and Questions
Preconditions:
0.01 Establish Communication
1.01 Select Claim Filing Service
Success Guarantee:
Caller provides information that can be used to establish a new UI Claim.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PROMPT: Military last 18 months?
ENTERS: ―Yes or No‖
IF “Yes”:
SET NAVFLAG = “Ability to take Military
claims‖
GOTO: 0.04 Queue to Skills-Based
Routing
PROMPT: Federal Government employment
last 18 months?
ENTERS: ―Yes or No‖
IF “Yes”:
SET NAVFLAG = “Ability to take Federal
claims‖
GOTO: 0.04 Queue to Skills- Based
Routing
PROMPT: Work in state other than California
last 18 months?
ENTERS: ―Yes or No‖
IF “Yes”:
SET NAVFLAG = “Ability to take
Combined Wage claims‖
IF NOT Military AND NOT Federal AND
NOT Combined Wage:
SET NAVFLAG = “Ability to take
California intra-state claims‖
GOTO: 0.04 Queue to Skills- Based
Routing
PROMPT: Applied for UI in another state
during last 12 months?
ENTERS: ―Yes or No‖
IF “Yes”:
SET NAVFLAG = “Ability to take
California intra-state claims‖ GOTO: 0.04
Queue to Skills- Based Routing
OTHERWISE:
SET NAVFLAG = Ability to file regular UI
Claims‖
GOTO: 0.04 Queue to Skills- Based
Routing
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Military = Y or N
Federal Gov = Y or N
Work Other State = Y or N
UI Other State = Y or N
Frequency of Occurrence:
Design Considerations:
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D.5.2 UC23 Use Case 1.08 ID Verification
The Claimant has been referred to the appropriate CSR from the Queue. In
cases of suspected deception, the CSR sends information to Insurance
Accounting Division (IAD) and proceeds to take the claim information.
This Use Case takes place outside the UCD.
Use Case Number
1.08
Use Case Name:
ID Verification
Goal:
To review identification information provided by the caller to establish identity or to infer
identity deception.
The Preamble
Actor Name:
CSR
Stakeholders and Interests:
Employers: Ensure taxes go to pay benefits to bona fide Claimants.
Legislature: Protect the public interest.
EDD: Detection and reduce fraud, protect the UI Trust Fund and information assets,
and maintain fiduciary responsibility.
Context:
Claim Filing
Certify for Benefits
Information and Questions
Preconditions:
0.04 Queued to Skills-Based Routing
Success Guarantee:
Claimant is confirmed as ―owner‖ of SSN or claim is referred to IAD for fraud
investigation.
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Use Case Body
Actor’s Actions (CSR) System Responses (UCD)
VERIFIES: Reviews SSN and employment
history with the caller.
ASKS Additional Verification Questions:
Driver’s License Number?
Prior claims?
Used other SSNs or names in past?
IF Inference of Identity Deception:
REFERS: Claim referred, not the
caller, to IAD for Investigation
FLAGS: System for ID investigation
message
Supplementary Details and Constraints
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
PIN will not be evaluated for potential fraud.
There may be additional questions added to the Claimant interview, based on other
EDD initiatives.
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D.5.3 UC24 Use Case 1.09 Complete Claim Filing
Much of the information necessary to file a claim will not be captured in the UCD.
The CSR gathers additional required information as a part of this Use Case. This
Use Case occurs outside of the UCD.
Use Case Number
1.09
Use Case Name:
Complete Claim Filing
Goal:
Complete the claim information so that it can be filed.
The Preamble
Actor Name:
CSR
Stakeholders and Interests:
Claimant: Claim is filed.
EDD: Achieve accuracy, completeness, and efficiency in the claim filing process.
Context:
Claims Filing
Preconditions:
1.08 ID Verification
Success Guarantee:
Claim is accurately filed in SCDB.
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Use Case Body
Actor’s Actions (CSR) System Responses (UCD)
GATHERS: Non-Monetary and Monetary
Eligibility Information from caller.
Review with the potential Claimant
identification and IC information and enter into
SCDB.
IF Federal Claim (UCFE):
Request copy of MA-8 (Fed ID
number)
IF Ex-Military Claim (UCX):
Request DD214
IF Non-Citizen of US:
Request current documentation and
documentation of Legal Right to Work
in last 19 months
GOTO: 0.012 Clarify Issues
OTHERWISE:
GOTO: 1.014 Wrap Up: Rights,
Responsibilities and Eligibility Information.
See Design Considerations.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
EDD to determine where the Rights and Responsibility statement will be during design.
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D.5.4 UC14 Use Case 1.012 Clarify Issues
In some cases, out-of-pattern eligibility responses can be clarified by the CSR so
that the claim proceeds to completion without issues. In other cases, the
Claimant needs to be referred for ―Fact-Finding‖ that will lead to an eligibility
determination. In this Use Case, the CSR attempts to clarify eligibility issues.
This Use Case occurs outside the UCD.
Use Case Number
1.012
Use Case Name:
Clarify Issues
Goal:
During the CSR interview, resolve unclear issues or send claim to be scheduled for
fact-finding.
The Preamble
Actor Name:
CSR
Stakeholders and Interests:
Claimant: Resolve issues and receive benefits.
EDD: Assure that benefits are paid appropriately to Claimants; assure that
unnecessary fact-finding is not scheduled.
Context:
Claim Filing
Certify for Benefits
Preconditions:
1.09 Complete Claim Filing
Success Guarantee:
Either issues are resolved or the claim is scheduled for fact-finding.
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Use Case Body
Actor’s Actions (CSR) System Responses
Questions caller on responses to issues
questions. Clears non-issues and refers other
issues to schedule for fact-finding.
IF All Issues Are Cleared:
GOTO: 1.014 Wrap Up: Rights,
Responsibilities and Eligibility
Information. See Design
Consideration.
OTHERWISE:
GOTO: 1.013 Schedule for Fact-
Finding
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations
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D.5.5 UC15 Use Case 1.013 Schedule for Fact-Finding
When the CSR is unable to clarify issues, the Claimant is scheduled for Fact-
Finding, the first step in adjudicating the issues to ultimately determine eligibility.
This process occurs using a scheduling system that is outside the UCD process.
Use Case Number
1.013
Use Case Name:
Schedule for Fact-Finding
Goal:
Schedule Claimant with potential eligibility issues for Fact-Finding interview.
The Preamble
Actor Name:
CSR
Stakeholders and Interests:
Claimant: Resolve issues with urgency to receive benefits.
EDD: Ensure that payments are appropriate and comply with First Payment Time
Lapse.
Context:
Claim Filing
Certify for Benefits
Preconditions:
1.012 Clarify Issues
Success Guarantee:
A Fact-Finding Interview has been scheduled.
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Use Case Body
Actor’s Actions System Responses
SCDB takes Agent to Scheduling System
Agent:
Identifies and records issues on
determination request screen
UISS
Schedules Claimant for available time
as appropriate to issue
Agent
Returns Claimant to UCD
READS: General Message on Fact-Finding
GOTO: 1.014 Wrap Up: Rights and
Responsibilities and Eligibility Information.
See Design Consideration.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
No Appointment Available System Message: You will be Scheduled later
notified later
Technology and Data Variations List:
Schedule for Fact-Finding = Y
Frequency of Occurrence:
Design Considerations:
The Scheduling System is currently being redesigned with features that are unknown and
may impact this Use Case.
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D.5.6 UC16 Use Case 1.014 Wrap Up: Rights, Responsibilities,
and Eligibility Information
This final Use Case in Filing Claims is used for all types of claims. The UCD
reads a series of messages regarding the payment process and eligibility for
benefits.
Use Case Number
1.014
Use Case Name:
Wrap Up: Rights, Responsibilities and Eligibility Information
Goal:
Provide consistent and accurate information to Claimants regarding rights,
responsibilities, and eligibility.
The Preamble
Actor Name:
CSR
Claimant
Stakeholders and Interests:
Claimant: Understand the claim process, payment system, and the things they have
to do to receive benefits.
EDD: Ensure that Claimant understands Rights and Responsibilities.
Context:
Claim Filing
Preconditions:
1.09 Complete Claim Filing
Clean (without issues) re-opened claims, will not go through 1.012 and 1.013 prior to
Wrap Up
Success Guarantee:
UCD READS Claimant rights, responsibilities, and eligibility information.
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Use Case Body
Actor’s Actions (CSR/Claimant) System Responses (UCD)
CSR: Directs Claimant Back to UCD
READS: Rights and Responsibilities
READS: Receiving Handbook, Award Notice,
Notice of Unemployment Insurance filed for
Claimant (1101C).
LOOK-UP: PIN System, does PIN exist?
IF “Yes”:
GOTO: Send information to UCD
Reporting/UI Data Warehouse
IF “NO”:
READS: PIN establishment
ENTERS: PIN PROMPT: Enter four-digit PIN
PROMPT: Confirm PIN
ENTERS: Confirmation
GOTO: 0.07 Send Information to UCD
Reporting/UI Data Warehouse
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Supplementary Details and Constraints
Alternative Flows (Variations):
Rights and Responsibilities may be included in the Queue to Skills-Based Routing instead
of the Wrap-Up.
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions
Technology and Data Variations List:
UCD:
Heard Wrap-Up Information = Y
Frequency of Occurrence:
Design Considerations:
1. Decision needs to be made regarding whether a Claimant is required to enter a
keystroke affirming that he/she has heard the Rights and Responsibilities
Statement. UI is not going to require affirmation that Claimant heard and
understood the information.
2. EDD to determine where the Rights and Responsibility statement will be during
design.
3. Two possible ways to establish PINs:
the Claimant may establish a PIN at the Wrap Up point, or
the Department may send a temporary EDD issued PIN to the Claimant
after the new claim is filed. The next time the Claimant calls the IVR he/she
would be forced to change the EDD issued PIN and select a personal PIN.
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D.6 Information and Questions
The Unemployment Insurance Program receives requests for information,
opportunities for feedback, and answers to question from three types of callers:
Unemployment Insurance Claimants, employers, and indeterminate callers
requesting general information. The Use Cases in this area are designed so that
the UCD assists in responding to these requests.
D.6.1 UC25 Use Case 2.01 Main Menu for Information and
Questions
Once a call has been directed to the ―Information and Questions‖ portion of the
UI UCD, it is necessary to identify whether the caller is a Claimant, an Employer,
or Other, and then direct the caller to the appropriate Use Case for handling the
caller’s inquiry. This Use Case documents the process flow to do so.
Use Case Number
2.01
Use Case Name:
Main Menu for Information and Questions
Goal:
Identify caller to ―Information and Questions‖ portion of UI UCD as a Claimant, an
Employer, or Other, and direct the caller to the appropriate Use Case to process the
caller’s inquiry.
The Preamble
Actor Name:
Caller – specific role to be identified by this Use Case
Stakeholders and Interests:
EDD: Save CSR
Department of Labor: Improved response time through more complete information
sooner
Employer: Protect reserve account from invalid / inaccurate claims
Context:
Information and Questions
Precondition:
0.01 Establish Communications
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Success Guarantee:
Caller has been identified as a Claimant, an Employer, or Other, and the call has
been directed to the appropriate Use Case to process the caller’s inquiry.
Use Case Body
Actor’s Actions (Caller) System Responses (UCD)
PROMPT:
Do you want information on your claim?
Are you an employer?
Do you have general questions regarding
ENTERS: Selection UI?
IF “want information on your claim”:
PROMPT: What is your inquiry
regarding?
PRESENTS MENU:
How to Complete a Form
Claim Information
Information Regarding ID Alert
Other Appointments
Appeals Information
Overpayment Information
1099 Information
Return to previous menu
Continued Claims
SELECTS: A response
Fraud
Out-System Referral
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Actor’s Actions (Caller) System Responses (UCD)
IF “How to Complete a Form”
GOTO: 2.02 How Do I Complete This
Form?
IF “Claim Information”
GOTO: 2.03 Claim Information
IF “Information Regarding ID Alert”
GOTO: 2.08 ID Alert Information Calls
IF “Other Appointments”
GOTO: 2.09 Inquiries About
Appointments
IF “Appeals Information”
GOTO: 2.10 Appeals Information
IF “Overpayment Information”
GOTO: 2.11 Overpayment Information
IF “1099 Information”
GOTO: 2.12 1099 Information
IF “Return to Previous Menu”
GOTO: Previous Menu
IF “Continued Claims”
GOTO: 3.0 Continued Claims
IF “Fraud”
GOTO: 2.13 Fraud Reporting
IF “Out of System Referral”
GOTO: 2.14 Out-System Referral
SELECTS: A response PRESENTS MENU:
Claimant’s selection (GOTO: Use case) will HANG-UP, EXIT to PREVIOUS MENU
determine menu selection.
IF “EMPLOYER”:
PROMPT: What is your inquiry
regarding?
PRESENTS MENU:
Reporting Potential Fraud
Appeals and Determinations
How Do I Complete This
Form?
Return to previous menu
SELECTS: A response
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Actor’s Actions (Caller) System Responses (UCD)
IF “Reporting Potential Fraud”
GOTO: 2.31 Fraud Reporting
IF “Appeals and Determinations”
GOTO: 2.32 Appeals and
Determinations
IF “How Do I Complete This Form?”
GOTO: 2.33 How Do I Complete This
Form
PRESENTS MENU:
HANG-UP, EXIT to PREVIOUS MENU, or
transfer to agent.
IF “transfer to agent”
SET NAVFLAG = ―Ability to answer
General Information Questions from
Employers‖
GOTO: 0.04 Queue to Skills- Based
Routing
IF “general UI information”:
PROMPT: What is your inquiry
regarding?
PRESENTS MENU:
Reporting Potential Fraud
Referral to Other Services
Information on the UI Process
Return to previous menu
SELECTS: A response
IF “Reporting Potential Fraud”
GOTO: 2.13 Fraud Reporting
IF “Referral to Other Services”
GOTO: 2.14 Out-System Referral
IF “Information About the UI Process”
GOTO: 2.15 Information about UI
Processes
PRESENTS MENU: HANG-UP, EXIT
to PREVIOUS MENU
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Actor Type = C or E or O
Frequency of Occurrence:
Design Considerations:
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D.6.2 UC26 Use Case 2.02 Claimant: How Do I Complete This
Form?
This Use Case documents the processing flow for a call from a Claimant seeking
information on how to complete a form. The UCD prompts the caller to enter a
form number. If the form is one that is made up of a ―family of forms,‖ the UCD
prompts for the name of the specific form within the family. The UCD provides
the caller with a tutorial on how to complete the form. If the caller wishes to
inquire about additional forms, then the process repeats until the caller has asked
about all of the forms in which he or she is interested. The UCD then asks the
caller if he or she would like additional information. If the caller answers in the
affirmative, then the UCD provides a website address. Finally, the UCD asks the
caller if he or she would like to return to the main menu, speak to a customer
service representative, or hang-up. Once the caller responds, the UCD routes
the call appropriately.
Optional processing that has been suggested includes:
For certain forms, the call should be directed to non-UI entities (e.g.,
Tax or Disability Insurance).
If there is no tutorial for the form that the caller is asking about, the
UCD should provide a website address, routing to a customer service
representative, or return to main menu.
Use Case Number
2.02
Use Case Name:
Claimant: How Do I Complete This Form?
Goal:
Give Claimant Guidance to Complete Form without agent assistance.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Improved response time through more complete information
sooner
Employer: Protect reserve account from invalid / inaccurate claims
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Context:
Information and Questions
Certify for Benefits
Precondition:
0.01 Establish Communications
Claimant has form(s) (it’s been sent to them; they’ve downloaded from website,
etc.)
Success Guarantee:
Claimant has all information/guidance required to complete form without assistance
from CSR.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PROMPT: Form number? (Explains where to
find the form number on forms)
ENTERS: Form number
IF “Family of Forms” (A, B,C, etc.
Variations):
PROMPT for specific form (i.e., in
these cases, need tree logic to get to
specific form)
ENTERS: Specific variation letter
READS: Form tutorial
PROMPT: Additional form number or ―none‖?
ENTERS: Specific form number or ―none‖ IF There Are Additional Form Numbers:
REPEAT the above steps for each
additional form UNTIL caller enters
―none‖
ENTERS: Specific form number until there are
no more forms about which to inquire and then
enters ―none‖
PROMPT: Additional information needed?
ENTERS: ―Yes or No‖
IF More Information Needed:
READS: website address
PROMPT: Complete the call, return to Main
Menu, or speak to an agent?
ENTERS: Selection
HANG-UP, EXIT to MENU, or GOTO: 0.04
Queue to Skills-Based Routing
Optionally: For certain forms, direct call to non-UI
entities (Tax, DI)
SELECTS: A response
IF No Tutorial On the Form That Caller is
Asking About:
READS: website address
PRESENTS MENU:
GOTO: 2.01 Main Menu for
Information and Questions; or
SET NAVFLAG = “Ability to answer
General Information Questions‖
GOTO: 0.04 Queue to Skills-Based
Routing
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Form number/letter entered by Prompt for re-entry (second
caller doesn’t exist chance)
IF still invalid:
Then provide website
address, EXIT to MENU, or
SET NAVFLAG = “Ability
to answer General
Information Questions‖
GOTO: 0.04 Queue to
Skills-Based Routing
Technology and Data Variations List:
Form Number = ????????
Family of Forms Variation = X
Frequency of Occurrence:
Design Considerations:
Need conditional branch to 2.09 Overpayment Information
During design, Menu for ―How do I complete this form?‖ needs to be made consistent
throughout the system.
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D.6.3 UC27 Use Case 2.03 Claimant: Claim Information
This Use Case documents the processing flow for a call from a Claimant seeking
information regarding his or her claim. The UCD first prompts the caller as to
whether the call is to (1) obtain the date and time of a determination interview, (2)
provide personal information change(s), (3) check on payment status, or (4)
inquire about additional information. If the caller is inquiring about the date and
time of a determination interview, then this Use Case branches to Use Case
―2.03 Inquiries about Determination Interview.‖ If the caller is calling to make
changes to personal information, then this Use Case branches to Use Case ―2.04
Personal Info Change.‖ If the caller is calling to check on payment status, then
this Use Case branches to Use Case ―2.05 Payment Status.‖
Use Case Number
2.03
Use Case Name:
Claim Information
Goal:
Route inquiries specific to information on claims
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Improve response time through more complete information sooner
Employer: Protect reserve account from invalid / inaccurate claim
Context:
Information and Questions
Certify for Benefits
Preconditions:
0.01 Establish Communications
Claimant has identified ―type of information call‖ as one for ―Claim Information‖ – page 7
of UCD Process Flow Diagram
0.02 Establish Identity when needed
0.03 Validate Identity when needed
Success Guarantee:
Call is routed to appropriate UCD script for specific claim inquiry type.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PROMPT: What is call regarding?
PRESENTS MENU:
Date and time of Determination
Interview?
Personal information change?
Payment status?
Additional information required?
SELECTS: A response
IF Date and Time of Determination
Interview:
GOTO: 2.04 Inquiries About
Determination Interview
IF Personal Information Change:
GOTO: 2.05 Personal Info Change
IF Payment Status:
GOTO: 2.06 Payment Status
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
1. Options need to be sequenced so that Claimant is referred to CSR only once.
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D.6.4 UC28 Use Case 2.04 Claimant: Inquiries about
Determination Interviews
This Use Case provides the Claimant with information regarding determination
interviews
The UCD prompts the caller for what the caller wishes to do: (1) obtain general
information about determination interviews, (2) find out when his or her
determination interview is scheduled, (3) change interview time, (4) change
telephone number (for interview only), or (5) conduct ―will call‖ interview.
If the caller wants general information, then the UCD plays a recorded message.
If the caller wants to know when his or her interview is scheduled, then the UCD
looks-up the information in a scheduling system and provides the information to
the caller. If the caller is calling to change the interview time, change the
telephone number for the determination interview or is calling in response to a
―will call‖ appointment, then the UCD routes the call appropriately.
Use Case Number
2.04
Use Case Name:
Inquiries about Determination Interviews
Goal:
Provide Claimant with Information re: Determination Interview and Capability to
Reschedule Interview Time or Change Phone Number (UCD must have READ access
to the Scheduling System)
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The Preamble
Actor Name:
Claimant
Employer
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Timely interviews (with minimal rescheduling)
Employer: Protect reserve account from invalid / inaccurate claims
Context:
Information and Questions
Preconditions:
0.01 Establish Communications
1.01 Establish Identity (when needed)
Success Guarantee:
Caller’s determination appointment date and time provided by the UCD without CSR
intervention. CSR’s Questions Answered, Information Updated as Appropriate (e.g., new
phone number), Date/Time Changed if Requested with CSR assistance.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PRESENTS MENU: What does caller want to
do re: Determination Interview?
General information?
Find out when Determination
Interview is scheduled?
Change interview time?
Change phone number?
Calling in for ―will call‖?
SELECTS: A response
IF Caller Wants General Information:
READS: recorded information
IF Caller Wants To Know When Interview Is
Scheduled:
GOTO: 2.04 Claimant; Inquiries about
Determination Interviews
IF Caller Wants To Change Interview Time:
READS: explanation of consequences
of delaying interview
PROMPT: still want to change
appointment?
IF “No”:
ENTERS: ―Yes‖ or ―No‖ PRESENT MENU:
Return to this Menu
Return to Main Menu
Exit
IF “Yes”:
SELECTS: A response SET NAVFLAG :‖Ability to change
determination appointments‖
GOTO: 0.04 Queue to Skills-Based
Routing
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Actor’s Actions (Claimant) System Responses (UCD)
IF Caller Wants To Change Phone Number
For the Determination Interview:
SET NAVFLAG : ―Ability to change
telephone numbers for det
appointments
GOTO: 0.04 Queue to Skills-Based
Routing
IF Caller is Calling for “Will Call”:
SET NAVFLAG = ―Ability to route to ―Will
Call‖ office
GOTO: 0.04 Queue to Skills-Based
Routing
Supplementary Details and Constraints
Alternative Flows (Variations):
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Scheduling System is GOTO: 0.04 Queue to Skills-
unavailable to UCD. Based Routing:
Manually reschedule.
Scheduling System is GOTO: 0.04 Queue to Skills-
unavailable. Based Routing:
Tell them to call back.
Technology and Data Variations List:
Phone Number = ―XXX.XXX.XXXX‖
Frequency of Occurrence:
Design Considerations:
1. EDD needs to decide content of the General Information message.
2. Constraint: UCD direct access to the scheduling system requires revision to current
scheduling system.
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D.6.5 UC29 Use Case 2.05 Claimant: Personal Info Change
This Use Case provides the Claimant with the option to update personal
information. The UCD prompts the caller for the type of change. If the caller
wishes to update information, then this Use Case branches to ―0.40 Queue to
Skills-Based Routing.‖ This Use Case takes place outside the UCD.
Use Case Number
2.05
Use Case Name:
Personal Info Change
Goal:
Direct the claimant to the correct agent who can update their personal information.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Gather personal information changes.
Department of Labor: Meet first payment time lapse
Employer: Protect reserve account from invalid / inaccurate payments
Context:
Information and Questions
Preconditions:
0.01 Establish Communications
There must be an existing claim on file.
Success Guarantee:
Callers are routed to a CSR for changes.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PRESENTS MENU: type of change?
Address and Telephone Number
Changes
SELECTS: A response Other
IF Address Change, Telephone Number
and Other Changes:
SET NAVFLAG = “Ability to change
personal information in SCDB and
answer General Information
Questions‖‖
GOTO: 0.40 Queue to Skills-Based
Routing
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
Should an alternative path for an Investigation Division investigation pending case be
created?
Is an alternative path for ID Alert needed?
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D.6.6 UC30 Use Case 2.06 Claimant: Inquiries about Payment
Status
This Use Case provides the Claimant with information regarding payments: date
of last check sent, benefits paid, and remaining claim balances. The UCD first
looks-up in non-UCD databases, the date of last payment, the amount of the last
payment, and the claim balance. The UCD then speaks this information to the
caller and asks the caller if the caller needs further information. If additional
information is needed, the UCD asks the caller if he or she would like to return to
the main menu or speak to a customer service representative (CSR), and directs
the call appropriately.
Use Case Number
2.06
Use Case Name:
Inquiries about Payment Status
Goal:
Provide Claimant with Information regarding: Payments, Remaining Claim Balances
and Last Check
The Preamble
Actor Name: Claimant
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Meet first payment time lapse
Employer: Protect reserve account from invalid / inaccurate payments
Context:
Information and Questions
Certify for Benefits
Preconditions:
0.02 Establish Identity
2.03 Claim Information
There must be an existing claim on file.
Success Guarantee:
The caller’s questions are answered.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
LOOK-UP In Flat File:
Date of last payment
Amount of last payment
Claim balance
SPEAKS:
Date of last payment
Amount of last payment
Claim balance
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PROMPT: more information required?
Enters: ―Yes‖ or ―No‖
IF “No”:
PRESENT MENU:
Claimant Information and Questions
Menu
Information and Questions Menu
Main Menu, or
Exit
IF “Yes”:
SELECTS: A response PRESENT MENU:
EXIT to 2.01 Main Menu for
Information and Questions
Speak to an Agent
Main Menu, or
Exit
IF Speak to an Agent:
SELECTS: A response SET NAVFLAG = “Ability to
answer General Information
Questions”
GOTO: 0.04 Queue to Skills-
Based Routing
IF Main Menu:
GOTO: 2.01 Main Menu for
Information and Questions
IF Exit:
GOTO: Use Case 0.08 Receive
Data Warehouse Information
from UCD
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
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Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Date of Last Payment = mmddyy
Amount of Last Payment = XXXX.XX
Claim Balance = XXXXX.XX
Frequency of Occurrence:
Design Considerations:
Elements used to establish PIN – today, Weekly Benefits Amount (WBA) must be
provided by Claimant to establish identity; thus, will we not use WBA in response to
Claimant inquiries?
Note: Menus in this Use Case may not be complete but serve as examples. Menus will
be added in each call flow process prior to exit during the design phase.
Exit Menu must be consistent throughout UCD, with option to go to agent where
needed.
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D.6.7 UC32 Use Case 2.08 Claimant: ID Alert Information Calls
This Use Case documents the processing flow for a call from a Claimant seeking
information about the ID Alert process. This Use Case prompts the caller to ask
if the caller is seeking ―general‖ information about the identity process. If the
caller responds affirmatively, then the UCD plays a recorded message containing
general information on the identity process. Otherwise, the UCD asks the caller
if the call is regarding (1) whether or not EDD has received documents, (2) status
of payment or determination, or (3) other.
If the caller wants to know if EDD has received documents, then the UCD
branches to Use Case 0.04 Queue Skills-Based Routing. If the caller is calling to
check the status of a payment then the UCD branches to Use Case 2.06
Inquiries about Payment Status. If the caller is calling about determination, the
UCD branches to 0.04 Queue to Skills-Based Routing.
Use Case Number
2.08
Use Case Name:
ID Alert Information Calls
Goal:
Provide information to Claimants about the ID Alert process without the assistance of
an agent.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Detection and reduce fraud, protect the UI Trust Fund and information assets,
and maintain fiduciary responsibility.
Employers: Ensure taxes go to pay benefits to bona fide Claimants.
Legislature: Protect the public interest.
Context:
Information and Questions
[Claimant calls in and has questions about forms they received (re: identity)]
Preconditions:
The following Use Cases was executed:
2.01 Information and Questions
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Success Guarantee:
Claimants receive information on Id Alert from the UCD or CSR that answers their
questions.
Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PROMPT: General information regarding the
identity process, ―Yes‖ or ―No.‖
ENTERS: ―Yes‖ or ―No‖
IF “Yes”:
Playback general information
OTHERWISE:
Go to next step
PRESENTS MENU:
Documents have been received
by EDD
Status of payment or
determination
Other
SELECTS: A response
IF Caller Wants to Know if Documents
Have Been Received by EDD:
READS: Timeframe and when to
call back
PRESENT MENU: If Past
Timeframe,
Exit or
GOTO: Information and Questions
Menu
IF Past Timeframe:
SET NAVFLAG: ―Ability to answer
ID Alert Questions‖
GOTO: 0.04 Queue to Skills-Based
Routing (IAD Identity)
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IF Status of Payment
READS: ID Alert Information and time
frames
GOTO: Use Case for ―2.06 Inquiries
About Payment Status
IF Past Timeframe:
SET NAVFLAG = “Ability to answer
ID Alert questions”
GOTO: 0.04 Queue to Skills-Based
Routing (IAD Identity)
IF Caller has “Other” Questions:
SET NAVFLAG = ―Ability to answer
ID elevated calls‖
GOTO: 0.04 Queue to Skills-Based
Routing
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
EDD needs to decide how and when the PIN will be issued (inside the UCD or through another
method).
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D.6.8 UC34 Use Case 2.10 Claimant: Inquiries about Appeals
This Use Case provides the caller with information regarding appeal rights,
appeal status, appeal results, and how to file an appeal or board appeal. The
UCD prompts the caller as to what the caller wants to know: (1) general
information, including how to file an appeal, (2) when an appeal is scheduled, or
(3) status of appeal. If the caller wants general information, then the UCD plays
a recorded message. If the caller wants to know when an appeal hearing is
scheduled or to check the status of an appeal, then the UCD routes the call
appropriately.
Use Case Number
2.10
Use Case Name:
Inquiries about Appeals
Goal:
Provide Claimant with Information re: Appeal Rights, Appeal Status, Appeal Results,
How to File Appeal or Board Appeal, What Happens Next.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Timely interviews (with minimal rescheduling)
Employer: Protect reserve account
Context:
Information and Questions
Preconditions:
There must be an existing claim on file.
Success Guarantee:
Caller’s Questions Answered
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
PRESENTS MENU: what does caller want to
know re: appeal?
General information, including how to
file? (Include 10 day rule giving
Department 10 days from mail date to
process appeals)
SELECTS: A response When appeal hearing is scheduled?
Status of appeal?
IF Caller Wants General Information:
READS: recorded information
IF Caller Wants to Know When Appeal
Hearing is Scheduled:
SET NAVFLAG = “Ability to answer
appeal Questions‖
GOTO: 0.04 Queue to Skills-Based
Routing
IF Caller Wants to Check Status of Appeal:
SET NAVFLAG = “Ability to answer
appeal Questions‖
GOTO: 0.04 Queue to Skills-Based
Routing
NOTES ON CSR STEPS
CSR checks Claim Record and provides
status, if available.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.6.9 UC35 Use Case 2.11 Claimant: Inquiries about
Overpayments
This Use Case provides the caller with information regarding overpayments. The
UCD asks the caller if the caller has (1) an established overpayment and wants
to make payment arrangements or (2) questions regarding overpayments. If the
caller is calling to make payment arrangements, then the UCD routes the call
appropriately. If the caller has questions, the UCD asks the caller to select a a
form number they received, or ―none‖ if the caller does not have a form. Then
the UCD routes the call appropriately.
Use Case Number
2.11
Use Case Name:
Claimant: Inquiries about Overpayments
Goal:
Provide Claimant with Information regarding Overpayments.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Accurate recovery of funds
Employer: Protect reserve account; protects Reimbursable Employer Funds
Context:
Information and Questions
Preconditions:
There must be a claim on file. The overpayment could be on a prior claim.
Success Guarantee:
Caller’s questions have been answered and information updated as appropriate.
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
READS: General Overpayment Information
PRESENTS MENU: does Claimant have:
An established overpayment and
want to make payment arrangements;
or
Questions regarding an overpayment
form that they received or general
overpayment questions.
SELECTS: A response
IF Payment Arrangements:
READS: Phone Number, then
GOTO: OUTSIDE TRANSFER
(NOTE: Tax (BOCS))
IF Questions Regarding Overpayment:
PROMPT:
If received form 1444, press 1
If received form 1447, press 2
For general overpayment questions,
press 3
ENTERS: Selection
IF Form Number = “1444”
SET NAVFLAG = ―Ability to answer
overpayment questions‖
GOTO: 0.04 Queue to Skills-Based
Routing (Overpayments Center)
IF Form Number = “1447”
SET NAVFLAG = ―Ability to answer
overpayment questions‖
GOTO: 0.04 Queue to Skills-Based
Routing (Insurance Accounting
Division)
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Supplementary Details and Constraints
Alternative Flows (Variations):
The Claimant may ―enter‖ this Use Case from the ―How to Complete Forms‖ Use Case.
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.6.10 UC36 Use Case 2.12 Claimant: Inquiries regarding 1099G
Forms
This Use Case ensures that taxable compensation on a 1099G is correct and
provides 1099 information, including mailed copies. The UCD reads a general
message on 1099s to the caller. Then, the UCD asks the caller if the caller
wants specific information. If the caller answers in the affirmative, the UCD asks
the caller if the caller (1) has a question on amounts reported on 1099G, (2) has
a question on the taxability of disability benefits used in lieu of UI, (3) wants a
copy of a 1099G, or (4) wants a copy of benefits paid. If the caller wants to know
the amounts reported on 1099G, the UCD tells the caller what the amounts are
(following a look-up to a non-UCD system). If the caller is questioning the
taxability of disability benefits used in lieu of UI or the amounts reported on a
1099G, then the UCD routes the call appropriately. If the caller wants a copy of a
1099G or a copy of benefits paid, then the UCD reads the address of record and
asks if it is correct. If correct, then reads recorded message that the copy(s) will
be sent and saves information to trigger an action to send copy(s). If not correct,
then routes for entry of new address and reads a recorded message that the
copy(s) will be sent and saves information to trigger an action to send the
copy(s).
Use Case Number
2.12
Use Case Name:
Claimant: Inquiries Regarding 1099G Forms
Goal:
Ensure that Taxable Compensation is correct on the Form 1099G and provide 1099
Information (including mailed copies)
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The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Save CSR time
IRS: Correct tax information
Context:
Information and Questions
Preconditions:
0.02 Establish Identity
0.03 Validate Identity
There is a valid claim on file.
Claimant has called:
Requesting copy of benefits paid and/or 1099G;
Stating they got a letter from the IRS saying that they received UI Benefits and they
say that they did not; NOTE: Need to develop Use Case where actor is other.
Questioning the amount of Benefits received as reported on 1099G; or questioning
the taxability of Disability Benefits used in lieu of UI.
Success Guarantee:
1099G corrected or amount confirmed, and explanation given;
Copies of 1099G sent; and/or
Payment listing and/or copies of checks sent
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Use Case Body
Actor’s Actions (Claimant) System Responses (UCD)
READS: General message on 1099G
PROMPT: Do you want specific information?
ENTERS: ―Yes‖ or ―No‖ IF “No”:
Exit to Menu
IF “Yes”:
PRESENTS MENU: What is specific
question?
Amounts reported on 1099G?
Taxability of Disability Benefits used
in lieu of UI?
Copy of 1099G?
Copy of benefits paid?
SELECTS: A response
IF Call is Requesting Amounts Reported
on 1099G:
LOOK-UP: Amount in 1099G System.
SPEAKS: Amounts to caller
IF Call is Questioning the Taxability of
Disability Benefits Used in Lieu of UI, or
the Amounts Reported on 1099:
SET NAVFLAG = ―Ability to handle
1099G in Insurance Accounting Division‖
GOTO: 0.04 Queue to Skills-Based
Routing (IAD)
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Actor’s Actions (Claimant) System Responses (UCD)
IF Caller Wants a Copy of 1099G
PROMPT: For current year, or for prior years
IF Current Year:
ENTERS: Selection LOOK-UP: address on file
SPEAKS: address on file
PROMPT: is address correct?
IF “Yes”:
ENTERS: ―Yes‖ or ―No‖ SAVES INFORMATION:
Trigger 1099 System to send 1099G to
Claimant
IF “No”:
PROMPT: speak correct address
RECORD: address in voice mailbox
(do not update claim record)
READS: message that copy will be
sent (Agent retrieves the information
and the form is sent to the new
address without updating the claim
record information)
IF Prior Year:
SET NAVFLAG = ―Ability to handle 1099
in Insurance Accounting Division‖
GOTO: 0.04 Queue to Skills-Based
Routing (IAD)
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Actor’s Actions (Claimant) System Responses (UCD)
IF Caller Wants a Copy of Benefits Paid:
PROMPT: For current year, or for prior years
IF Current Year:
ENTERS: Selection LOOK-UP: address on file
SPEAKS: address on file
PROMPT: is address correct?
IF “Yes”:
ENTERS: ―Yes‖ or ―No‖ SAVES INFORMATION: send copy of
benefits paid
READS: message that form will be
sent within a specified number of days.
Trigger to send benefits paid to
Claimant.
IF “No”:
PROMPT: speak correct address
RECORD: address in voice mailbox
(do not update claim record)
READS: message that copy will be
sent (Agent retrieves the information
and the form is sent to the new
address without updating the claim
record information)
IF Prior Year:
SET NAVFLAG = ―Ability to handle
benefits paid questions in Insurance
Accounting Division‖
GOTO: 0.04 Queue to Skills-Based
Routing (IAD)
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Amount = XXXXXXX.XX
Address on file = text string
Trigger to send 1099G = Y or N (―on‖ or ―off‖)
Frequency of Occurrence:
Design Considerations:
Needs link from 2.01 How do I complete a form?
Requires that an Interface be built with the 1099 System.
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D.6.11 UC37 Use Case 2.13 Other: Fraud Reporting
This Use Case asks a caller, other than an employer, if the caller is a victim of
identity theft. If so, the UCD routes the call appropriately. Otherwise, the UCD
transfers the call to the fraud hotline.
Use Case Number
2.13
Use Case Name:
Other – Fraud Reporting
Goal:
Fraud Detection
The Preamble
Actor Name:
Other (Note: Does not include Employer)
Stakeholders and Interests:
EDD: Save CSR time and improve fraud detection
Department of Labor: Protection of the UI general trust fund
Employees (not necessarily Claimants and not the caller): Protect personal information
Employers: Protection of the UI general trust fund
Context:
Information and Questions
Preconditions:
0.01 Use Case: Establish Communications
Success Guarantee:
Caller gets connected to fraud hotline or CSR to report identity theft.
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Use Case Body
Actor’s Actions (Other) System Responses (UCD)
PROMPT:
IF you are a victim of identity theft, press
one.
IF you are reporting fraud, press two.
ENTERS: ―One‖ or ―Two‖
IF “One”:
SET NAVFLAG = ―Ability to handle
identify theft in Insurance Accounting
Division‖
GOTO: 0.04 Queue to Skills- Based
Routing (IAD)
IF “Two”
SET NAVFLAG = ―Fraud Hotline‖
READS: Fraud Hotline Number
GOTO: OUTSIDE TRANSFER
(Fraud Hotline)
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.6.12 UC38 Use Case 2.14 Other: Out-System Referral
This Use Case refers the caller to the appropriate entity if the caller has
questions about non-UI services or entities. The UCD asks the caller if the
caller’s question is about Job Services or other. If the answer is “other,” then
the UCD plays a recorded message that provides phone numbers for other
EDD services and related entities. Otherwise, the UCD asks the caller if the
caller wants general information on Job Services or wishes to use the Job
Service locator. If the caller wants general information, the UCD plays a
recorded message and exits to a previous menu. If the caller wants to use the
Job Service locator, the UCD prompts the caller for the caller’s zip code, looks-up
the nearest office for that zip code (using non-UCD databases), and provides the
office location to the caller.
Use Case Number
2.14
Use Case Name:
Out-System Referral
Goal:
Refer caller to appropriate entity (Job Service Locator or other entity) if the Caller has
questions about non-UI services or entities.
The Preamble
Actor Name:
Other
Stakeholders and Interests:
EDD: Save CSR time
Other entities receiving referrals: Get business
Context:
Information and Questions
Preconditions:
0.01 Use Case: Establish Communications
Success Guarantee:
Caller does not need agent assistance
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Use Case Body
Actor’s Actions (Other) System Responses (UCD)
PROMPT: JS or other?
ENTERS: JS or Other
IF Other:
READS: message (Phone #s for other
EDD services and related entities)
EXIT: to 2.01 Main Menu for
Information and Questions
PROMPT: General JS info or JS office
locator?
ENTERS: General or office locator
IF “General”:
READS: message
EXIT: to 2.01 Main Menu for
Information and Questions
If “Locator”:
PROMPT: What is caller’s Zip code?
ENTERS: Zip code
LOOK-UP: Office from Zip
SPEAKS: Location of JS Office
EXIT: to 2.01 Main Menu for Information and
Questions
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Supplementary Details and Constraints
Alternative Flows (Variations):
Caller may wish to transfer to outside referral for DI, PFL, TAX. OUTSIDE TRANSFER if
caller wants more information or they could return to menu.
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User (UCD)
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Zip Code Table is unavailable GOTO: 0.04 Queue to Skills-
to UCD. Based Routing.
Handle manually (with printed
office directory, if necessary).
Technology and Data Variations List:
Zip Code = XXXXX-XXXX
Frequency of Occurrence:
Design Considerations:
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D.6.13 UC39 Use Case 2.15 Other: Information on UI Processes
This Use Case provides the caller with information on the UI program. The UCD
asks the caller if the caller seeks employer information or claim information. If
the caller is seeking claim information, the UCD asks the caller about the caller’s
specific area of interest. The UCD plays a recorded message for the caller
regarding the specific area of interest and then asks the caller if he or she would
like to process a request in that area. If the caller replies affirmatively, then the
UCD routes the call appropriately. If the caller is seeking employer information,
the UCD asks the caller about the caller’s specific area of interest. The UCD
plays a recorded message for the caller regarding the specific area of interest
and then asks the caller if he or she would like to process a request in that area.
If the caller replies affirmatively, then the UCD routes the call appropriately.
Use Case Number
2.15
Use Case Name:
Other: Information on UI Processes
Goal:
Provide general information on the Unemployment Insurance Program.
The Preamble
Actor Name:
Other
Stakeholders and Interests:
EDD: Provide consistent information to callers regarding the UI program
Context:
Information and Questions
Preconditions:
0.01 Establish Communications
Success Guarantee:
Customer receives information requested
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Use Case Body
Actor’s Actions (Other) System Responses (UCD)
PRESENTS MENU:
Claim Information?
Employer Information
Report Fraud
DI, PFL, or TAX Information
SELECTS: A response
IF Claim:
PRESENTS MENU: Area of interest?
Initial Claims
o Qualifying for benefits
o Claim filing Out-of-State
o Claim filing School
employees
o Military and Federal Claims
Continued Claims
o Payments
o How do I file CCs?
o School Attendance
o Part-time work and wages
Notice of Overpayment
Appeals
Fraud (Include number for hot
line)
GOTO: 2.13 Other: Fraud
Reporting
Out of Service Referral (DI,
JS, or Tax)
GOTO: 2.14 Out-System
Referral
SELECTS: A response (Area of Interest)
Each area selected will have a sub-menu
PROMPT
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Actor’s Actions (Other) System Responses (UCD)
IF Initial Claims
PRESENTS MENU:
o Qualifying for benefits
o Claim filing Out-of-State
o Claim filing School
employees
o Military and Federal Claims
SELECTS: A response READS: Information about selection
At the end of each selection:
EXIT MENU:
File Claim
Claim Menu
Main Menu
Exit System
SELECTS: A response
IF File Claim:
SET NAVFLAG = “Claim Filing”
GOTO: 0.04 Queue to Skills-Based
Routing
IF Continued Claims:
PRESENTS MENU:
o Payments
o How do I file CCs?
o School Attendance
o Part-time work and wages
SELECTS: A response
READS: Information about
selection
At the end of each selection:
EXIT MENU:
Payment Information
Claim Menu
SELECTS: A response Main Menu
Exit System
IF Payment Information:
GOTO: 2.06 Inquiries about Payment
Status (will need to GOTO 0.02 and
0.03 to Establish and Validate Identity).
Include logic (if come from pB-20 to
0.02, then GOTO 0.03 before GOTO
1.01 File Claim)
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Actor’s Actions (Other) System Responses (UCD)
IF Notice of Overpayment
GOTO: 2.11 Inquiries about
Overpayments
IF Appeals:
GOTO: 2.10 Inquiries About
Appeals
IF (Employer ―falls through‖ to here):
PROMPT: Area of interest?
Forms related to Unemployment
Insurance
Notice on Notice of Wages
Notice of Determination and/or Ruling
Information about Determination
Hearing
Notice of Claim filed
Notice of Benefit Audit
Employer Responsibilities (General)
Appeals
Fraud
ENTERS: Selection Calling for Determination Hearing
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Actor’s Actions (Other) System Responses (UCD)
Each area selected will provide general
information and then take to specific USE
CASE or PRESENTS MENU:
Forms related to Unemployment
Insurance
GOTO: 2.02
Notice on Notice of Wages
READS: general information
Notice of Determination and/or Ruling
READS: general information
Notice of Claim filed
READS: general information
Notice of Benefit Audit
READS: general information
Employer Responsibilities READS:
general information
Appeals
GOTO: 2.32
FRAUD: general Information
GOTO: 2.31
Determination Hearing:
SET NAVFLAG: ―ER calling for det
hearing‖
GOTO: 0.04 Queue to Skills-Based
Routing
After READS in each area above:
PRESENT MENU:
Return to general employer
information
General information
Main Menu
Exit the system
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
This information should be consistent with the EDD website.
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Not updated as policy changes System will not update If policies are not updated in
information as policy changes UCD, users will get out-of-
outside the system. Must be a date information
manual process. (The EDD
must put a procedure in place
for this to occur).
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
There is no automated way to make information consistent between the website and
UCD. May require investment of staff resources.
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D.6.14 UC41 Use Case 2.31 Employer: Fraud Reporting
This Use Case routes an employer wishing to report potential fraud to the fraud
hotline.
Use Case Number
2.31
Use Case Name:
Employer – Fraud Reporting
Goal:
Fraud Detection
The Preamble
Actor Name:
Employer
Stakeholders and Interests:
EDD: Save CSR time and improve fraud detection
EDD/Department of Labor/State of California: Protect the UI general trust fund
Employees (not necessarily Claimants): Protect personal information
Other Employers (i.e., other than the caller): Protect the UI general trust fund
Context:
Information and Questions
Preconditions:
0.01 Use Case: Establish Communications
Success Guarantee:
Caller gets connected to fraud hotline
Use Case Body
Actor’s Actions (Employer) System Responses (UCD)
SET NAVFLAG = ―Fraud Hotline‖
GOTO: OUTSIDE TRANSFER
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.6.15 UC42 Use Case 2.32 Employer: Inquiries about
Determinations and Appeals
This Use Case provides an employer with information about employee
determinations and appeals. The UCD asks the employer if he or she: (1) wants
general information, (2) is returning a call, (3) wants to file an appeal, or (4)
wants to check the status of an appeal. If the employer wants general
information, the UCD plays a recorded message of general information. If the
employer wants to file an appeal, then the UCD plays a recorded message. If
the caller is returning a call or wants to check the status of an appeal or
determination, the UCD routes the call appropriately.
Use Case Number
2.32
Use Case Name:
Employer: Inquiries about Determinations and Appeals
Goal:
Provide Employers with Information regarding Employee Determinations and Appeals
The Preamble
Actor Name:
Employer
Stakeholders and Interests:
EDD: Save CSR time
Department of Labor: Timely Determinations
Claimant – Timely Determination resolution and more accurate information
Context
Information and Questions
Employer is (1) returning a call re: Determination or (2) wants to file or check status of an
Appeal
Preconditions:
Success Guarantee:
Employer Receives Information regarding Determinations and Appeals.
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Use Case Body
Actor’s Actions (Employer) System Responses (UCD)
GOTO: 2.15 Other Information on UI
Processes use Employer Information menu
PROMPT: Area of interest?
Forms related to Unemployment
Insurance
Notice on Notice of Wages
Notice of Determination and/or Ruling
Determination hearing
Notice of Claim filed
Response to Employer
Communication
Notice of Benefit Audit
Employer Responsibilities (General)
Appeals
Fraud
ENTERS: Selection
Each area selected will provide general
information and then take to specific use
case or presents menu:
Forms related to Unemployment
Insurance
GOTO: 2.02
Notice on Notice of Wages
READS: general information
Notice of Determination and/or Ruling
READS: general information
Notice of Claim filed
READS: general information
Notice of Benefit Audit
READS: general information
Employer Responsibilities READS:
general information
FRAUD: general Information
GOTO: 2.31
IF caller wants general information:
READS: Message
IF Determination Hearing:
SET NAVFLAG=”ER
Determination hearing‖
GOTO: 0.04 Queue to Skills-
Based Routing
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Actor’s Actions (Employer) System Responses (UCD)
IF Appeal Information:
GOTO: 2.10 Inquiries about Appeals
PRESENTS MENU: Employer Appeal
General Appeal Information
File an Appeal
SELECTS: A response Returning Call
Status of Appeal
IF General Appeal Information:
READS: General Information
IF File an Appeal:
READS: Information
IF Returning Call:
SET NAVFLAG = ―Ability to answer
appeal information‖
GOTO: : 0.04 Queue to Skills-
Based Routing
IF Status of Appeal
SET NAVFLAG: ―Ability to answer
appeal questions‖
GOTO: : 0.04 Queue to Skills-
Based Routing (Claim Holding Office)
NOTE ON CSR PROCESSING
CSR checks Claim Record and provides
status, if available.
IF no status available in Claim Record, tell
caller to call Office of Appeals.
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
Employers may call in for third party hearings. Details to be worked out during design phase.
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D.6.16 UC43 Use Case 2.33 Employer: How Do I Complete This
Form?
This Use Case documents the processing flow for a call from an employer
seeking information on how to complete a form. The UCD prompts the caller to
enter a form number. If the form is one that is made up of a ―family of forms,‖ the
UCD prompts for the name of the specific form within the family. The UCD
provides the caller with a tutorial on how to complete the form. If the caller
wishes to inquire about additional forms, then the process repeats until the caller
has asked about all of the forms in which he or she is interested. The UCD then
asks the caller if he or she would like additional information. If the caller answers
in the affirmative, then the UCD provides a website address. Finally, the UCD
asks the caller if he or she would like to return to the main menu, speak to a
customer service representative, or hang-up. Once the caller responds, the UCD
routes the call appropriately.
Optional processing that has been suggested includes:
For certain forms, direct the call to non-UI entities (e.g., Tax or
Disability Insurance).
If there is no tutorial for the form that the caller is asking about, the
UCD should provide a website address, routing to a customer service
representative, or return to main menu.
Use Case Number
2.33
Use Case Name:
Employer: How Do I Complete This Form?
Goal:
Provide Employer with Information to Complete Form without Assistance from CSR
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The Preamble
Actor Name:
Employer
Stakeholders and Interests:
EDD: Save CSR time (ultimately) and collect information needed for processing
Department of Labor: Improved response time through more complete information
sooner
Context:
Information and Questions
Preconditions:
Employer has form (it’s been sent to them, they’ve downloaded from website, etc.)
Success Guarantee:
Employer has all information/guidance required to complete form without assistance from
CSR
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Use Case Body
One Use Case for all UI forms (Employer and Claimant) 2.02
Actor’s Actions (Employer) System Responses (UCD)
PROMPT: Form number? (explaining where
to find the form number)
ENTERS: Form number
IF Family of Forms (A, B,C, etc.,
Variations):
PROMPT: Specific form? (i.e., in
these cases, need tree logic to get to
specific form)
ENTERS: Specific variation letter
READS: Form tutorial
PROMPT: Other forms?
ENTERS: ―Yes‖ or ―No‖
IF “Yes”:
REPEAT: Logic above until ―No‖
PROMPT: More information needed?
ENTERS: ―Yes‖ or ―No‖
IF “No”:
GOTO: 2.01 Main Menu for
Information and Forms
IF “Yes”:
READS: Website address and
SET NAVFLAG = ―Ability to answer
General Information Questions -
employer‖
GOTO: Queue to Skills-Base Routing.
Optionally: For certain forms, direct call to non-UI entities
(Tax, DI)
IF No Tutorial on the(UI) Form That Caller
is Asking About:
READS: Website address, or
SET NAVFLAG = ―Ability to answer
General Information Questions -
employer‖
GOTO: 0.04 Queue to Skills-Based
Routing
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Form number/letter entered by Prompt for re-entry (second
caller doesn’t exist chance)
If still invalid, then provide
website address, EXIT to
MENU, or GOTO: 0.04 Queue
to Skills-Based Routing
Technology and Data Variations List:
Form Number = ????????
Family of Forms Variation = X
Frequency of Occurrence:
Design Considerations:
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D.7 Continued Claims Use Cases
The third major area of UCD functionality is the Continued Claims process.
Claimants call the UCD on a bi-weekly basis to establish their eligibility for UI
benefits. The UCD sends information to SCDB database. Eligible Claimants are
paid benefits.
D.7.1 UC44 Use Case 3.0 Continued Claims: Pre-Screening
This process identifies Claimants and provides preliminary screening.
Use Case Number
3.0
Use Case Name:
Pre-Screening
Goal:
Identify and filter out those Claimants that require additional services prior to certifying
for weekly benefits
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD – ensure that only those Claimants that can be served by the limited functionality
offered have access to that service
Context:
Use Case – Continued Claims Certification
Preconditions:
0.02 Establish Identity
Success Guarantee:
Claimants with address changes, reportable work or reportable wages are directed to
certify on their paper form and exited from the certification application.
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Use Case Body
Actor’s Actions System Responses
Core Actions: READS: Advise Claimant of penalties for not
reporting work and earnings
PROMPT: Does Claimant require an address
change?
Enters: ―Yes‖ or ―No‖ If “No”:
PROMPT: Does Claimant need to
report work and wages?
Enters: ―Yes‖ or ―No‖ If “No”:
GOTO: 3.1 Determine Weeks
Otherwise:
READS: Claimant cannot use
telephone system to certify and directs
to another channel.
EXITS
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
None
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.2 UC45 Use Case 3.1 Continued Claims: Determine Weeks
The Claimant is eligible for certain weeks. This Use Case matches the weeks of
eligibility to the Claimant so that the eligibility certification can proceed.
Use Case Number
3.1
Use Case Name:
Determine Weeks
Goal:
Identify for this Claimant the week(s) that would be appropriate for certification
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD – ensure that a Claimant is certifying to the specific week(s) allowable under the
guidelines of CUIC and Title 22.
Context:
Use Case – Continued Claims Certification
Preconditions:
Pre-Screening
Success Guarantee:
Claimants are only presented with the opportunity to certify to eligibility for weeks
allowable under the guidelines of CUIC and Title 22.
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Use Case Body
Actor’s Actions System Responses
Core Actions: LOOK-UP: Using SSN find active claim and
last weekly certification, number of weeks
issued, benefit year end, balance, claim type,
disqualifications, and appeals.
IF Two Weeks: Calculate first week begin
and end dates and second week begin and
end dates
IF One Week: Calculate first week begin and
end dates
IF Multiple Weeks: Calculate the beginning
and ending dates of each week.
Enters: ―Yes‖ or ―No‖ (to acknowledge advice
and intent to proceed) SPEAKS: Begin date(s) and false statement
advice and instructions on how to proceed
SAVES INFORMATION: Yes or No
GOTO: 3.2 Capture Eligibility Statements
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Supplementary Details and Constraints
Alternative Flows (Variations):
Certain disqualifications (e.g. False Statements) can be lifted after the prescribed number of
weeks has been served. If a False Statement is found the Claimant has to otherwise be eligible
for the week in order for it to be credited. The weeks should be allowed to proceed.
Special Requirements:
Each disqualification found during the look-up will require further detail to establish handling
conditions. Detail design will need to establish the rules that govern each area of eligibility.
Exceptions:
Exception or Error Recovery Action Effect on User
Week one ending date greater READS: Claimant is at the
than Benefit Year End end of their benefit year
GOTO: 1.02 File New Claim
Zero balance in claim READS: Claimant has Claimant is provided
exhausted benefits. Announce information on any extended
extended benefit options benefits options
GOTO: 1.02 File New Claim
―Special claim‖ READS: Claim type requires Exit out
certification information that
cannot be captured over the
phone. Use paper.
Week ending date(s) between READS: Claim type requires Exit out
CTB begin and end dates certification information that
cannot be captured over the
phone. Use paper.
Week ending date(s) between IF appeal is active A disqualification under
disqualification period Continue appeal is payable
Otherwise:
READS: Claim has See Alternate Flow
previous disqualification
that prevents certification
Week ending date(s) greater READS: Claimant is too early Exit out
than current date
Too much time has lapsed READS: Break in service. Claimant needs to re-
since last weekly certification Claimant must file Additional establish continued claim
/Reopened Claim. status
GOTO: 1.01 Select Claim
Filing Service
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.3 UC46 Use Case 3.2 Continued Claims: Capture Eligibility
The Claimant responds to a number of questions provided to the UCD to
establish eligibility.
Use Case Number
3.2
Use Case Name:
Capture Eligibility
Goal:
Collect from the Claimant a complete set of responses to the compliance conditions for
each week of unemployment benefits being claimed
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Determine Weeks has identified the number of weeks for certification
Success Guarantee:
Claimant has provided one response to each eligibility condition for each week being
claimed.
Continued Claims Certification Requirements:
California Title 22, §1326, California Unemployment Insurance Code (CUIC) §1326.
Voluntary Federal Income Tax (VFIT) Deduction, CUIC §1342.1(3).
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Use Case Body
Actor’s Actions System Responses
Core Actions: SPEAKS: Please answer all of the following
questions as they apply to week {week one
beginning date} through {week one ending
date}.
Step 1 - GOTO: 3.3 Able
Step 2 - GOTO: 3.4 Available
Step 3 - GOTO: 3.5 Efforts to Seek Work
Step 4 - GOTO: 3.6 Refused Suitable Work
Step 5 - GOTO: 3.7 Began Training
IF One Week Certification: Continue
Otherwise:
SPEAKS: Please answer all of the following
questions as they apply to week {week two
beginning date} through {week two ending
date}.
Step 1 - GOTO: 3.3 Able
Step 2 - GOTO: 3.4 Available
Step 3 - GOTO: 3.5 Efforts to Seek Work
Step 4 - GOTO: 3.6 Refused Suitable Work
Step 5 - GOTO: 3.7 Began Training
PROMPT: Do you want Federal Income Tax
withheld from your benefits?
SAVES INFORMATION
ENTERS: ―Yes‖ or ―No‖
GOTO: 3.8 Submission
Repeat Until
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Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions.
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.4 UC47 Use Case 3.3 Continued Claims: Able
The Claimant must be able to work in order to receive benefits.
Use Case Number
3.3
Use Case Name:
Able
Goal:
Determine whether or not there is an issue of compliance with the Claimant’s ability to
work.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Capture Eligibility
Success Guarantee:
Claimant has provided one response to each compliance condition surrounding the
Claimant’s ability to work according to CUIC § 1253C (Able) and §1253.5 (Benefit
Reduction Days).
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Use Case Body
Actor’s Actions System Responses
Core Actions: PROMPT: Were you too sick or injured to
work?
ENTERS: ―Yes‖ or ―No‖ IF No:
SAVES INFORMATION
IF Yes:
PROMPT: Enter the number of days (1
ENTERS: ―1‖, ―2‖, ―3‖, ―4‖, ―5‖, ―6‖, ―7‖ thru 7) that you were too sick or injured
to work during this week.
IF 7
SAVES INFORMATION:
AAH Issue
Otherwise:
SAVES INFORMATION:
Benefit Reduction (1-6)
GOTO: 3.2 Capture Eligibility Step 2
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions.
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.5 UC48 Use Case 3.4 Continued Claims: Available
The Claimant must be available to accept employment in order to receive
benefits.
Use Case Number
3.4
Use Case Name:
Available
Goal:
Determine whether or not there is an issue of compliance with the Claimant’s availability
for work.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Capture Eligibility
Success Guarantee:
Claimant has provided one response to each compliance condition surrounding the
Claimant’s availability for work according to CUIC § 1253C (Available).
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Use Case Body
Actor’s Actions System Responses
Core Actions: PROMPT: Was there any reason other than
sickness or injury that you could not have
accepted {full or part time} work each
workday?
ENTERS: ―Yes‖ or ―No‖
IF No:
SAVES INFORMATION
IF Yes:
SAVES INFORMATION:
AA issue
GOTO: 3.2 Capture Eligibility Step 03
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions.
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.6 UC49 Use Case 3.5 Continued Claims: Efforts to Seek Work
A Claimant must be actively seeking employment to receive benefits.
Use Case Number
3.5
Use Case Name:
Efforts to Seek Work
Goal:
Determine whether or not there is an issue of compliance with the Claimant’s work
search requirement
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Capture Eligibility
Success Guarantee:
Claimant has provided one response to each compliance condition surrounding the
Claimant’s work search efforts according to CUIC § 1253e (Effort to Seek Suitable
Work).
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Use Case Body
Actor’s Actions System Responses
Core Actions: PROMPT: Did you look for work?
ENTERS: ―Yes‖ or ―No‖ IF “Yes”:
SAVES INFORMATION
IF “No”:
SAVES INFORMATION:
ES issue
GOTO: 3.2 Capture Eligibility Step 4
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions.
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.7 UC50 Use Case 3.6 Continued Claims: Refused Suitable
Work
If a Claimant has refused an offer of suitable work (an opportunity to return to
work), benefits are not paid.
Use Case Number
3.6
Use Case Name:
Refused Suitable Work
Goal:
Determine whether or not there is an issue of compliance with the Claimant’s
requirement to accept suitable work offers.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Capture Eligibility
Success Guarantee:
Claimant has provided one response to each compliance condition surrounding the
Claimant’s acceptance of suitable work offers according to CUIC § 1257b and 1258
(Refused Suitable Work).
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Use Case Body
Actor’s Actions System Responses
Core Actions: PROMPT: Did you refuse any work?
ENTERS: ―Yes‖ or ―No‖ IF “No”:
SAVES INFORMATION
IF “Yes”:
SAVES INFORMATION:
SW issue
GOTO: 3.2 Capture Eligibility Step 5
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions.
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
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D.7.8 UC51 Use Case 3.7 Continued Claims: Began Training
Claimants who are in certain types of approved training are excepted from work
search requirements.
Use Case Number
3.7
Use Case Name:
Began Training
Goal:
Determine whether or not there is an issue of compliance regarding school or training.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Capture Eligibility
Success Guarantee:
Claimant has provided one response to each compliance condition surrounding the
Claimant’s attendance in school or training according to CUIC § 1269 thru 1272
(California Training Benefits and Training Extension).
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Use Case Body
Actor’s Actions System Responses
Core Actions: PROMPT: Did you begin attending any kind of
school or training? If you are already enrolled
in approved training and your program has not
changed, answer no.
ENTERS: ―Yes‖ or ―No‖
IF “No”:
SAVES INFORMATION
IF “Yes”:
SAVES INFORMATION:
TA Issue
GOTO: 3.2 Capture Eligibility
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
See UC 0.11 Standard
Exceptions.
Technology and Data Variations List:
Frequency of Occurrence:
CTB Claimants are approximately 12,843 / week (667,804 / year).
Routes for out of pattern due to school are approximately 21,629 / week (1,124,716 / year).
NOTE: Figures do not reflect the seasonal nature (re: capacity on a weekly / yearly basis) of
school attendance.
Design Considerations:
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D.7.9 UC52 Use Case 3.8 Continued Claims: Submission
Once the input has been accepted, the UCD reads a statement of penalties
associated with false submission and submits information to SCDB.
Use Case Number
3.8
Use Case Name:
Submission
Goal:
Advise the Claimant that the system has accepted the certification(s) and a confirmation
that the Claimant understands the penalties associated with false information or
withheld facts.
The Preamble
Actor Name:
Claimant
Stakeholders and Interests:
EDD: Protect the integrity of the UI Fund
Department of Labor: Enforce compliance with Federal laws, regulations and
performance metrics
Employers: Ensure benefits are paid to eligible Claimants
Context:
Use Case – Continued Claims Certification
Preconditions:
Capture Eligibility
Success Guarantee:
Claimant has acknowledged an understanding of the penalties associated with providing
false information or withholding facts according to CUIC § 1257a (False Statement) and
§1264 (Satisfactory Immigration Certification under Penalty of Perjury).
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Use Case Body
Actor’s Actions System Responses
Core Actions: PROMPT: Do not hang up until you are told
that your certification has been accepted or
your certification will not process. Because
you are certifying for benefits over the phone,
you submit your answers by entering your 4-
digit PIN number if you agree with the
following statement:
―I agree that the information I have provided is
true and correct, and I understand that if I
submitted false information or withheld facts, I
may be subject to penalties under the law. I
also declare under penalty of perjury that I am
a US citizen or national, or an alien in
satisfactory immigration status and are
permitted to work by the Department of
Homeland Security.‖
If you agree with the statement and wish to
complete your certification, enter your 4-digit
PIN number now.
GOTO: 0.03 Validate Identity
ENTERS: PIN
IF Identity Confirmed:
READS: Your certifications have
been accepted. You will either
receive a check or an announcement
regarding questions with your
eligibility.
Exit out
AD897911-990E-46A1-B82D-75CD529435DB.DOC MARCH 23,
OFFICE OF SYSTEMS INTEGRATION RFP OSI 7100-181
UIMOD PROJECT APPENDIX D — PAGE 123 0F 123
Supplementary Details and Constraints
Alternative Flows (Variations):
Special Requirements:
Exceptions:
Exception or Error Recovery Action Effect on User
st
No PIN provided (timeout – 1 PROMPT: for entry
try)
nd
No PIN provided (timeout – 2 READS: direct to paper form
try) or advise to call during normal
business hours
PIN does not match (Invalid - PROMPT: Does not match.
st
1 try) Try again.
PIN does not match (Invalid - READS: direct to paper form
nd
2 try) or advise to call during normal
business hours
Caller Error or System GOTO: 0.11 Standard Transparent
Unavailable Exceptions
Technology and Data Variations List:
Frequency of Occurrence:
Design Considerations:
Validate Identity Use Case may need to be changed if it is appropriate to use the PIN to act as a
―digital signature‖.
AD897911-990E-46A1-B82D-75CD529435DB.DOC MARCH 23,
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