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Disability Insurance and Paid Family Leave – Forms and Publications

All documents on this page are PDFs. Some are samples only. A few forms let you fill them out on your computer. To do this, download and save the form on your computer. Then open them with the free Adobe Reader to fill them out.

You can file your Disability Insurance (DI) or Paid Family Leave (PFL) claim by:

  • Using myEDD to access SDI Online (recommended).
  • Mailing us one of these forms:
    • Application for Disability Insurance Benefits (DE 2501)
    • Application for Paid Family Leave Benefits (DE 2501F)

You must use an original paper application form. You cannot print or download a copy. You can get paper applications by:

  • Ordering an application online to have it mailed to you.
  • Getting the application from your physician/practitioner or employer.
  • Visiting an SDI Office.
  • Calling us to request a paper application by mail. When prompted, say “Claim form” and follow the instructions on the recording.
    • Disability Insurance 1-800-480-3287.
    • Paid Family Leave 1-877-238-4373.

Note: Allow up to ten days to receive this form by mail.

The Online Forms and Publications page has all our documents. Many are available to order at no cost. We send them to you by US mail. The web page also includes other publications for you to view and download.

To find documents:

  1. Visit Online Forms and Publications.
  2. Select Keyword(s) or Form Number from the dropdown.
  3. Select Search.

Important: Some forms cannot be ordered or downloaded because we send them to you when needed for your claim.

Example: Physician/practitioner’s Supplementary Certificate (DE 2525XX) to extend a disability claim. You will receive this form with your final payment. If your disability lasts longer than the original period stated on your claim, have your physician/practitioner complete and submit the DE 2525XX.  

Your physician/practitioner can find and file this form online using myEDD to access SDI Online or you can give them your paper form. If you lost or did not receive the DE 2525XX, you can request another form. Use your SDI Online account or call 1-800-480-3287 or 1-866-658-8846 (en español).

  • Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts
  • Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts in Dollar Increments
  • State Disability Insurance Bookmark

Forms

You can only use this form if you are the claimant's next of kin or are legally allowed to represent them.

Publications

  • Important Information for Disability Insurance (DI) Claimants
  • Fact Sheet: Disability Insurance Elective Coverage Program

Forms

Example PFL claim forms for reference only:

You can only use DE 1850J and DE 2522/DE 2522J if you are the care recipient’s next of kin or are legally allowed to represent them.

Note: English version claim forms cannot be downloaded or reproduced. Spanish claim forms are provided in a downloadable version and may be filled out and printed.

Publications

  • Paid Family Leave Bonding Benefits Information Sheet
  • Important Information for Paid Family Leave (PFL) Claimants
  • Paid Family Leave Booklet
  • Fact Sheet: California Paid Family Leave for Military Families

These notices are required to be posted in the workplace where all employees can see them.

Use this poster when employees are covered by Unemployment Insurance, Disability Insurance, and Paid Family Leave:

Use this poster when employees are covered only by Disability Insurance and Paid Family Leave:

When an employee files a claim, we send you a notification. You cannot order or download these notices. By law, you must respond within two working days:

  • Notice to Employer of Disability Insurance Claim Filed (DE 2503) – We send this after the employee files a DI claim. It asks you to verify the information the employee provided on their claim. If you have an SDI Online account, you can find it in your Inbox. You can use SDI Online or the paper form to respond.
  • Notice of Paid Family Leave (PFL) Claim Filed (DE 2503F) – We send this after the employee has filed a PFL claim. It asks you to verify the information the employee provided on their claim. Return the completed paper form to us to verify the employees’ claim information. This form is not currently available online.

Important: Employers are required to provide new employees and workers who request leave with Disability Insurance and Paid Family Leave information brochures. The digital brochures may be downloaded and provided as official notices to employees:

  • SDI Online Tips for Employers

Forms

Example forms for reference only:

  • Request for Continued Benefits – Physician/Practitioner’s Supplementary Certificate (DE 2525XX)
    • Access this form by logging in to your myEDD account and selecting SDI Online. Or complete this certification using the paper form that your patient will receive by mail with their final payment. Fill out all P/P certificate questions including descriptions and ICD codes. Make sure to sign, date, provide license number and phone number.
  • Paid Family Leave (PFL) Supplemental Claim Certification(DE 2525XFA)
    • Access this form by logging in to your myEDD account and selecting SDI Online. You can also complete this certification using the paper form that your patient will receive by mail with their final payment. Fill out Physician/Practitioner certificate questions 1 through 4, sign, date, provide license number and phone number.

Publications

  • Physician/Practitioner’s Guide to Disability Insurance
  • Licensed Health Professionals’ Guide to Paid Family Leave
  • Tip Sheet: SDI Online Tips for Licensed Health Professionals

Forms

Follow these steps to submit your forms:

  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.

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.

Publications

To order hard copies, use the Online Forms and Publications page.

  • Disability Insurance Elective Coverage Pamphlet (Digital Version)
  • Disability Insurance Elective Coverage Rate Notice and Instructions for Computing Annual Premiums
  • Disability Insurance and Paid Family Leave Weekly Benefit Amounts
  • Disability Insurance and Paid Family Leave Weekly Benefit Amounts in Dollar Increments
  • Fact Sheet: California Paid Family Leave
  • Fact Sheet: Disability Insurance Elective Coverage Program Fact Sheet
  • Information Concerning Elective Coverage for State Disability Insurance and Paid Family Leave
  • Information Sheet: Elective Coverage for Employers and Self-Employed Individuals
  • Information Sheet: Specialized Coverage (Elective Coverage for Exempt Workers)

Forms

Voluntary Plan Applications

Annual Plan Text Reports

Annual Financial Reports – Due Annually on February 15

Security Deposit and Updates – Due Annually on April 15

Contact Forms – Due Annually on June 15

Claim Reporting Forms

Claim Information

Tax Reporting

You can submit these forms online with e-Services for Business.

Publications

General Release Letters

NDI is not automated. You must request and fill out paper forms to start your claim or extend the medical part of a claim.

Ask your personnel specialist or payroll officer to obtain the NDI claim forms DE 8501 and DE 8501F. Your employer must confirm your job status and complete Part A before you complete Part B. Contact us at 1-866-758-9768 to get medical extension forms.

Forms

Publications