<?xml version="1.0" encoding="UTF-8"?>
<!-- edited with XMLSpy v2010 rel. 2 (http://www.altova.com) by Nina Thayer (CA Dept. of Industrial Relations) -->
<xs:schema xmlns="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/GoldenRodLien" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:FF="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields" xmlns:CD="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains" xmlns:CF="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/CommonFields" targetNamespace="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Forms/GoldenRodLien" elementFormDefault="qualified" attributeFormDefault="unqualified">
	<xs:import namespace="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/FormFields" schemaLocation="../../common/FormFields/FormFields.xsd"/>
	<xs:import namespace="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/Formdomains" schemaLocation="../../common/FormDomains/FormDomains.xsd"/>
	<xs:import namespace="http://www.dir.ca.gov/dwc/EAMS/PresentTermSolution/Schemas/Common/CommonFields" schemaLocation="../../common/CommonFields/CommonFields.xsd"/>
	<xs:simpleType name="lienTypeCode">
		<xs:annotation>
			<xs:documentation>Lien Type 
			Valid Values 
				'O' - Original Lien 
			</xs:documentation>
		</xs:annotation>
		<xs:restriction base="CF:typeCode1">
			<xs:enumeration value="O"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:simpleType name="proofOfServiceText">
		<xs:restriction base="xs:string">
			<xs:minLength value="0"/>
			<xs:maxLength value="1323"/>
			<xs:whiteSpace value="preserve"/>
		</xs:restriction>
	</xs:simpleType>
	<xs:group name="LienInformationSectionGroup">
		<xs:sequence>
			<xs:element name="DateOfOriginalLien" type="CF:ptsDate"/>
			<xs:element name="LienType" type="lienTypeCode" fixed="O"/>
			<xs:element name="SocialSecurityNumber" type="FF:socialSecurityNumber" minOccurs="0"/>
			<xs:element name="DateOfBirth" type="CF:ptsDate" minOccurs="0">
				<xs:annotation>
					<xs:documentation>DOB of injured worker</xs:documentation>
				</xs:annotation>
			</xs:element>
		</xs:sequence>
	</xs:group>
	<xs:element name="GoldenRodLien">
		<xs:annotation>
			<xs:documentation>Golden Rod Lien Form</xs:documentation>
		</xs:annotation>
		<xs:complexType>
			<xs:sequence>
				<xs:element name="HeaderSection" type="HeaderSection"/>
				<xs:element name="InjuryTypeSection" type="InjuryType"/>
				<xs:element name="LienInformationSection" type="LienInformation"/>
				<xs:element name="InjuredWorkerSection" type="CD:PersonInformation"/>
				<xs:element name="LienClaimantSection" type="LienClaimant"/>
				<xs:element name="LienClaimantAttorneyOrRepSection" type="CD:AttorneyorRepWithoutNumber" minOccurs="0"/>
				<xs:element name="EmployerSection" type="CD:OrganizationInformation" minOccurs="0"/>
				<xs:element name="InsuranceCarrierOrClaimsAdministratorSection" type="CD:OrganizationInformation" minOccurs="0"/>
				<xs:element name="EmployerOrClaimsAdminAttorneySection" type="CD:OrganizationInformation" minOccurs="0"/>
				<xs:element name="OpeningLien" type="UnemploymentCompensation" minOccurs="0"/>
				<xs:element name="AdditionalLien" type="UnemploymentCompensation" minOccurs="0"/>
				<xs:element name="AmendedLien" type="AmendedLien" minOccurs="0"/>
				<xs:element name="ProofOfServiceAndSignature" type="ProofOfServiceAndSignature"/>
			</xs:sequence>
		</xs:complexType>
	</xs:element>
	<xs:complexType name="HeaderSection">
		<xs:sequence>
			<xs:element name="VersionNumber" type="CF:versionNumber" fixed="0.1"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="LienClaimant">
		<xs:sequence>
			<xs:element name="EmployerName" type="FF:employerName"/>
			<xs:element name="Address" type="CD:Address"/>
			<xs:element name="PhoneNumber" type="FF:phoneNumber"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="LienClaimantAttorneyOrRep">
		<xs:sequence>
			<xs:element name="LienClaimantNotRepresented" type="CD:CheckBox"/>
			<xs:element name="AttorneyOrRepWithoutNumber" minOccurs="0">
				<xs:complexType>
					<xs:sequence>
						<xs:element name="AttorneyorAuthRepTypeCode" type="FF:attorneyorAuthRepTypeCode"/>
						<xs:element name="EmployerName" type="FF:employerName" minOccurs="0"/>
						<xs:element name="Name" type="CD:PersonName"/>
						<xs:element name="Address" type="CD:Address"/>
						<xs:element name="PhoneNumber" type="FF:phoneNumber" minOccurs="0"/>
					</xs:sequence>
				</xs:complexType>
			</xs:element>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="LienInformation">
		<xs:group ref="LienInformationSectionGroup"/>
	</xs:complexType>
	<xs:complexType name="UnemploymentCompensation">
		<xs:group ref="UnemploymentCompensationGroup"/>
	</xs:complexType>
	<xs:complexType name="NameGroup">
		<xs:sequence>
			<xs:group ref="CD:PersonNameGroup" minOccurs="0"/>
			<xs:element name="EmployerName" type="FF:fullName" minOccurs="0"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="ProofOfServiceAndSignature">
		<xs:sequence>
			<xs:element name="DateOfProofOfService" type="CF:ptsDate"/>
			<xs:element name="ProofOfServiceText" minOccurs="0">
				<xs:simpleType>
					<xs:restriction base="xs:string">
						<xs:maxLength value="1323"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="SignatureOfLienClaimant">
				<xs:simpleType>
					<xs:restriction base="FF:signature">
						<xs:minLength value="1"/>
						<xs:maxLength value="40"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="AmendedLien">
		<xs:sequence>
			<xs:element name="AmendedLienSDIWeeklyRate" minOccurs="0">
				<xs:simpleType>
					<xs:restriction base="FF:amount">
						<xs:maxInclusive value="99999999999.99"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="AmendedLienPFLWeeklyRate" minOccurs="0">
				<xs:simpleType>
					<xs:restriction base="FF:amount">
						<xs:maxInclusive value="99999999999.99"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="AmendedLienTotal" minOccurs="0">
				<xs:simpleType>
					<xs:restriction base="FF:amount">
						<xs:maxInclusive value="9999999.99"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="AmendedLienGroup" type="AmendedLienDomain" minOccurs="0" maxOccurs="5"/>
		</xs:sequence>
	</xs:complexType>
	<xs:complexType name="InjuryType">
		<xs:group ref="CD:InjuryTypeAndDates"/>
	</xs:complexType>
	<xs:group name="UnemploymentCompensationGroup">
		<xs:sequence>
			<xs:element name="UnemploymentCompensationType" type="FF:lienUnemploymentCompensationType"/>
			<xs:element name="LienWeeklyRate">
				<xs:simpleType>
					<xs:restriction base="FF:amount">
						<xs:maxInclusive value="99999999999.99"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="DateOfBenefitsCommencing" type="CF:ptsDate"/>
			<xs:element name="LienTotalBenefitsNotToExceed">
				<xs:simpleType>
					<xs:restriction base="FF:amount">
						<xs:maxInclusive value="99999999999.99"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
		</xs:sequence>
	</xs:group>
	<xs:group name="AmendedLienGroup">
		<xs:sequence/>
	</xs:group>
	<xs:complexType name="AmendedLienDomain">
		<xs:sequence>
			<xs:element name="NumberOfDays">
				<xs:simpleType>
					<xs:restriction base="xs:int">
						<xs:minInclusive value="0"/>
						<xs:maxInclusive value="999"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="AmendedLienDailyBenefitRate">
				<xs:simpleType>
					<xs:restriction base="FF:amount">
						<xs:maxInclusive value="99999.99"/>
					</xs:restriction>
				</xs:simpleType>
			</xs:element>
			<xs:element name="Dates" type="CD:DateRangeMandatory"/>
			<xs:element name="UnemploymentCompensationType" type="FF:lienUnemploymentCompensationType"/>
		</xs:sequence>
	</xs:complexType>
</xs:schema>
