Disability Insurance – Forms and Publications

The documents on this website are PDFs. To complete forms, you may need to download and save them on the computer, then open them with the no-cost Adobe Reader.

To search and order brochures and forms from the EDD, visit Online Forms and Publications. All are available at no cost, whether you download or order for delivery by mail.

Forms

• Claim for Disability Insurance (DI) Benefits (DE 2501) – English: You must submit an original form provided by the EDD, either electronically or through US mail. It cannot be downloaded or reproduced. To submit the DE 2501 electronically, visit How to File a Disability Insurance Claim in SDI Online. To submit by US mail, visit How to File a Disability Insurance Claim by Mail.
  
  To order this form to submit by mail:
  • Visit Online Forms and Publications.
  • Select Keyword(s) or Form Number from the dropdown.
  • Enter DE 2501 for an English form or DE 2501/S for a Spanish form.
  • Select Search.
    
    

  To view an example DI claim form for reference only, review the DE 2501 – Sample claim form or the DE 2501/S – Spanish sample claim form.

• First Claim for Nonindustrial Disability Insurance (DE 8501): Disability claim form for excluded state employees.
  
  
• If you are under the care of an accredited religious practitioner, you can download and print this form. Have your religious practitioner complete and sign the Claim for Disability Insurance Benefits – Religious Practitioner’s Certificate (DE 2502) before sending it to the EDD. A licensed physician or practitioner cannot complete this form.
  
  
• Declaration of Individual Claiming Benefits Due an Incapacitated or Deceased Claimant (DE 2522/DE 2522J): Form to claim benefits on behalf of a deceased or incapacitated claimant.
  
  
• Physician/Practitioner’s Supplementary Certificate (DE 2525XX): You will receive a Physician/Practitioner’s Supplementary Certificate (DE 2525XX) with your final payment. If your disability will extend beyond the original period established on your claim, have your physician/practitioner complete and submit the DE 2525XX.  Your physician/practitioner can find and file this form online using SDI Online or you can provide them with a paper form. If you lost or did not receive the DE 2525XX, you can request the form using your SDI Online account or by calling 1-800-480-3287 or 1-866-658-8846 (en español).
  
  
• Annual Income Report for Disability Insurance Elective Coverage (DE 945).
  
  
• Application for Disability Insurance Elective Coverage (DE 1378DI).

Publications

• Appeal Fact Sheet
  • DE 1001
• Notice to Employees
  • DE 1857A - English
  • DE 1857A/A - Armenian
  • DE 1857A/CC - Chinese-Cantonese
  • DE 1857A/CM - Chinese-Mandarin
  • DE 1857A/P - Punjabi
  • DE 1857A/S - Spanish
  • DE 1857A/T - Tagalog
  • DE 1857A/V - Vietnamese
• Notice to Employees
  (Employers Note: This poster is required to be posted in the workplace of employees who are covered only by Disability Insurance. If your employees are covered by Unemployment Insurance, please post the DE 1857A.)
  • DE 1858 - English
  • DE 1858/S - Spanish
• Disability Insurance Provisions - To order forms, please use the Online Forms and Publications page.
  • DE 2515D - English (Digital)
  • DE 2515/A - Armenian
  • DE 2515/CC - Chinese-Cantonese
  • DE 2515/CM - Chinese-Mandarin
  • DE 2515/P - Punjabi
  • DE 2515/S - Spanish
  • DE 2515/T - Tagalog
  • DE 2515/V - Vietnamese
• Important Information for Disability Insurance (DI) Claimants
  • DE 2515P
• Physician/Practitioner’s Guide to Disability Insurance
  • DE 2548
  Disability Insurance Elective Coverage - To order forms, please use the Online Forms and Publications page.
  • DE 2565 - English (Digital)
• Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts
  • DE 2588
• Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts in Dollar Increments
  • DE 2589
• Nonindustrial Disability Insurance Provisions
  • DE 8502 - English
• Tip Sheets
  • SDI Online Tips for Claimants – DE 8515 - English
  • SDI Online Tips for Claimants – DE 8515/S - Spanish
  • SDI Online Tips for Licensed Health Professionals – DE 8516 - English
  • SDI Online Tips for Employers – DE 8518 - English
• Transitioning from Disability Insurance to Paid Family Leave 
  • DE 8521 - English
  • DE 8521/A - Armenian
  • DE 8521/CC - Chinese-Cantonese
  • DE 8521/CM - Chinese-Mandarin
  • DE 8521/K - Korean
  • DE 8521/P - Punjabi
  • DE 8521/T - Tagalog
  • DE 8521/V - Vietnamese
• Fact Sheets
  • Disability Insurance Program – DE 8714C - English
  • Disability Insurance Program – DE 8714C/A - Armenian
  • Disability Insurance Program – DE 8714C/CC - Chinese-Cantonese
  • Disability Insurance Program – DE 8714C/CM - Chinese-Mandarin
  • Disability Insurance Program – DE 8714C/P - Punjabi
  • Disability Insurance Program – DE 8714C/S - Spanish
  • Disability Insurance Program – DE 8714C/T - Tagalog
  • Disability Insurance Program – DE 8714C/V - Vietnamese
  • Disability Insurance Elective Coverage Program – DE 8714CC - English
  • State Disability Insurance (SDI) Online – DE 8714DI - English
  • State Disability Insurance (SDI) Online – DE 8714DI/S - Spanish
• SDI Online Bookmark for Claimants
  • DE 8717D - English
  • DE 8717D/S - Spanish
• State Disability Insurance Bookmark
  • DE 8717DI