How to File a Paid Family Leave Claim by Mail

To get your paper Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form, you can:

• Order online to have it mailed to you within ten days.
• Ask your physician/practitioner or employer for a form.
• Visit an SDI Office.
• Call 1-877-238-4373 to request a paper form by mail.
  • California Relay Service (711) for hearing and speech impaired users – provide the PFL number (1-877-238-4373) to the operator.

New mothers transitioning from a Disability Insurance (DI) related pregnancy claim to bonding: When you have recovered from delivering your baby, a Claim for Paid Family Leave (PFL) Benefits – New Mother (DE 2501FP) will be automatically mailed to you in a separate envelope at the same time your final disability payment is issued.

You must provide the following information to file a PFL claim:

• First and last name.
• Current employer’s business name, phone number, and mailing address (from your W-2 or paystub).
• Last date you worked your normal hours.
  • If you have an EDD Client Number (ECN) from a previous DI or PFL claim, you can use that in place of an SSN.

Information you may also need:

• Any wages you received or expect, like sick leave, paid time off (PTO), vacation pay, annual leave, or wages earned after you stopped working.
• Worker compensation claim information.
• Proof of relationship for bonding claims.
• Statement of Care Recipient and Physician/Practitioner’s Certification for care claims.
• Military assist documentation.

Submit claims no later than 41 days from the date you wish to begin your bonding claim.

If you have an EDD Client Number (ECN) from a previous DI or PFL claim, you can use that in place of an SSN.

New mothers moving from a DI-related pregnancy claim to a bonding claim:

• Complete all sections of the Claim for Paid Family Leave (PFL) Benefits – New Mother (DE 2501FP).
  • No additional documentation is required.

Other Bonding claims:

• Complete Part A, Claimant’s Statement (page 1), of the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form.
• Complete Part B - Bonding Certification (page 2) of the DE 2501F form.
• Provide Proof of Relationship for:
• Mothers without a pregnancy DI claim.
• New fathers.
• Foster parents.
• Adoptive parents.

Care claims:

• Complete Part A, Claimant’s Statement (page 1), of the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form.
• Complete Part C - Statement of Care Recipient (page 3) of the DE 2501F.
• Have your physician/practitioner complete Part D - Physician/Practitioner’s Certification (page 4) of the DE 2501F.

Note: If you file by mail and your physician/practitioner wishes to submit Part D – Physician/Practitioner’s Certificate using SDI Online, they should allow five business days for us to receive and process your claim.

After your paper claim has been received, your physician/practitioner can search for your claim in SDI Online using the last four digits of your Social Security number, last name, and date of birth.

It is your responsibility to have them complete and sign the form and submit it to us within 41 days from the date your family leave begins, or you may lose benefits.

Military assist claims:

• Complete Part A, Claimant’s Statement (page 1), of the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form.
• Complete Part E - Military Assist Certification (page 5).
• Complete Part E - Qualifying Event for Leave (page 6).
• Provide military documentation, including at least one of the following:
• Covered active-duty orders.
• Letter of impending call or order to covered active duty.
• Military leave signed by the approving authority for the military member's rest and recuperation.
• Provide qualifying event documentation, which may include:
• A copy of a meeting announcement for informational briefings sponsored by the military.
• A copy of a bill for services for the handling of legal or financial affairs.
• A letter with detailed information (reason for meeting, location, contact information) for the meeting with a third party.

Mail your completed claim form using the pre-addressed envelope included with your form, if you don’t have it, mail your form to:

State of California
Employment Development Department
P.O. Box 989315
West Sacramento, CA 95798-9315

To avoid delays, complete the paper form as follows:

• Use black ink only.
• Type or write clearly within the boxes provided.
• Provide all requested information.
• Fill out only Part A – Statement of Claimant and the appropriate section for bonding, care, or military assist.
• Do not complete any portion of the DE 2501F Part D – Physician/Practitioner’s Certificate.
• A properly completed application will include:
• For bonding, parts A, B, and supporting documents.
• For care, parts A, C, and D.
• For military assist, parts A, E, and supporting documents.
• Do not forget to sign your form.
• Make sure to put a stamp on the envelope.
• Mail your claim no earlier than the first day your family leave begins, but no later than 41 days after your family leave begins or you may lose benefits.
• Do not submit duplicates of the same claim. This will delay claim processing.

Note: Your employer will be notified that you have submitted a PFL claim; however, any medical information is confidential and will not be shared with your employer.