Disability Insurance – Elective Coverage Forms and Publications

Follow These Steps

1. Select the form you need.
2. Enter your information into the fields as directed on the form.
3. Print two copies of the form. Keep one for your records and mail one to us.
   • Annual Income Report for Disability Insurance Elective Coverage (DE 945)
   • Application for Disability Insurance Elective Coverage (DE 1378DI)
   • Application For Unemployment Insurance, State Disability Insurance, And Paid Family Leave Elective Coverage Under Section 708(A) Of The California Unemployment Insurance Code (CUIC) (DE 1378a)
   • Request for Preliminary Worker Classification Assessment or Audit Lead Referral (DE 230)

Note: You are reporting confidential information on these forms. Do not use email or other unsecure methods of communication to send these forms to us.

• Disability Insurance Elective Coverage Pamphlet
  • DE 2565 - English
  • DE 2565/S - Spanish
• Disability Insurance Elective Coverage (DIEC) Rate Notice and Instructions for Computing Annual Premiums
  • DE 3DI-I
• 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
• Fact Sheet: California Paid Family Leave
  • DE 8714cf
• Fact Sheet: Disability Insurance Elective Coverage Program Fact Sheet
  • DE 8714CC - English
• Information Concerning Elective Coverage for State Disability Insurance
  • DE 1378p
• Information Sheet: Elective Coverage for Employers and Self-Employed Individuals
  • DE 231EC
• Information Sheet: Specialized Coverage (Elective Coverage for Exempt Workers)
  • DE 231sc
• Instructions For Reporting Wages And Contributions For Employers Who Have Elected Unemployment And State Disability Insurance Coverage Under Section 708(A) Of The California Unemployment Insurance Code (CUIC)
  • DE3f
• State Disability Insurance Bookmark
  • DE 8717DI