Paid Family Leave Forms
Paid Family Leave Claim Form
Claim for Paid Family Leave (PFL) Benefits - An original form must be submitted by claimants. It cannot be downloaded or reproduced. If you are a woman currently receiving SDI pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits. You will automatically be sent a Claim for Paid Family Leave (PFL) Benefits - New Mother, DE 2501FP, when your pregnancy-related disability claim ends. If you have not received this form within 10 days after your disability claim ends please contact us at the telephone number below.
To order a Claim Form for Paid Family Leave Benefits Form DE 2501F (Rev 12/03), please call 1-877-238-4373. Deaf, speech impaired and hard of hearing callers can contact PFL directly by Teletypewriter (TTY) 1-800-445-1312 (this number does not accept voice calls).
- For an example of a properly completed Claim for Paid Family Leave (PFL) Benefits Form DE 2501F for individuals claiming benefits to provide care or bond, see the sample claim form.
To order brochures and forms from EDD, please use the Online Forms and Publications page.
Report of Voluntary Plan Family Leave (VPFL) Claim - DE 2523F.
Self-Service Options
- SDI Online
- Disability Insurance Automated Phone Information System
- Paid Family Leave Automated Phone Information System
- Disability Insurance Office Locations
- Paid Family Leave Office Locations
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