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Forms

• Claim for Paid Family Leave (PFL) Benefits (DE 2501F): You must submit an original form provided by the EDD, either electronically or through US mail. This form cannot be downloaded or reproduced. To submit the DE 2501F electronically, visit How to File a Paid Family Leave Claim in SDI Online. To submit the DE 2501F by US mail, visit How to File a Paid Family Leave Claim by Mail.
  
  To order the DE 2501F to submit by mail:
  • Visit Online Forms and Publications.
  • Select Keyword(s) or Form Number from the dropdown.
  • Enter DE 2501F and select Search.
    
    
  To view an example PFL claim form for reference only, review the DE 2501F – Sample claim form.

• Solicitud de Beneficios del Programa de Permiso Familiar Pagado (PFL) (DE 2501F/S): Spanish instructions and form to submit your PFL bonding or care claim. You can download and print this form. Complete and sign all parts before sending it to the EDD. To submit by US mail, visit How to File a Paid Family Leave Claim by Mail.

• Claim for Paid Family Leave (PFL) Care Benefits (DE 2501FC): If you submit your PFL claim electronically, you must submit the DE 2501FC to complete your claim, which includes the care recipient’s authorization and the physician/practitioners certification. To submit the DE 2501FC electronically, go to SDI Online.

• Solicitud de Beneficios del Programa de Permiso Familiar Pagado (PFL) para Proveer Cuidado (DE 2501FC/S): To submit the DE 2501FC/S electronically, go to SDI Online.

• Claim for Nonindustrial Disability Insurance - Family Care Leave (NDI-FCL) (DE 8501F): Family leave 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 Practitioner’s Certification for Paid Family Leave (PFL) Benefits (DE 2502F) before sending it to the EDD. A licensed physician or practitioner cannot complete this form.

• Request to Re-establish a Bonding Claim for Paid Family Leave (DE 2504RE): To submit the DE 2504RE electronically, go to SDI Online.

• Declaration of Individual Acting as Authorized Representative for Incapacitated or Deceased Care Recipient (DE 1850): Form to authorize a representative for a deceased or incapacitated person to establish eligibility for PFL benefits.

• Declaration of Individual Claiming Benefits Due an Incapacitated or Deceased Claimant (DE 2522): Form to claim benefits on behalf of a deceased or incapacitated claimant.

Note: If you are a woman currently receiving Disability Insurance 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. Complete the DE 2501FP to receive PFL bonding benefits.

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

• Appeal Fact Sheet
  • DE 1001
• Notice to Employees
  Note: This poster is required to be posted in the workplace of employees who are covered by Unemployment Insurance and SDI.
  • DE 1857A - English
  • DE 1857A/A - Armenian
  • DE 1857A/CC - Cantonese
  • DE 1857A/CM - Mandarin
  • DE 1857A/P - Punjabi
  • DE 1857A/S - Spanish
  • DE 1857A/T - Tagalog
  • DE 1857A/V - Vietnamese
• Notice to Employees
  Note: This poster is required to be posted in the workplace of employees who are covered only by Disability Insurance. If your employees are also covered by Unemployment Insurance, please post the DE 1857A.
  • DE 1858 - English
  • DE 1858/S - Spanish
• Guide for Completing a Claim Form for Paid Family Leave (PFL) Benefits
  • DE 2475 - English
  • DE 2475/A - Armenian
  • DE 2475/CC - Chinese-Cantonese
  • DE 2475/CM - Chinese-Mandarin
  • DE 2475/P - Punjabi
  • DE 2475/S - Spanish
  • DE 2475/T - Tagalog
  • DE 2475/V - Vietnamese
• Paid Family Leave
  Note: Employers are required to provide the Paid Family Leave brochure only to new employees and persons who request leave to care for a seriously ill family member or bond with a new child. These brochures may be downloaded and provided as official notices to employees.
  • DE 2511 - English
  • DE 2511/A - Armenian
  • DE 2511/CC - Chinese-Cantonese
  • DE 2511/CM - Chinese-Mandarin
  • DE 2511/P - Punjabi
  • DE 2511/S - Spanish
  • DE 2511/T - Tagalog
  • DE 2511/V - Vietnamese
• Important Information for Paid Family Leave (PFL) Claimants
  • DE 2515PF
• Licensed Health Professionals’ Guide to Paid Family Leave
  • DE 2548FD
• 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
• 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
• Paid Family Leave Booklet
  • DE 8520 - English
• Paid Family Leave Flyer
  • DE 8519 - English
  • DE 8519/A - Armenian
  • DE 8519/CC - Chinese-Cantonese
  • DE 8519/CM - Chinese-Mandarin
  • DE 8519/P - Punjabi
  • DE 8519/S - Spanish
  • DE 8519/T - Tagalog
  • DE 8519/V - Vietnamese
• Transitioning from Disability Insurance to Paid Family Leave DE 8521 - English
• Paid Family Leave – DE 8714CF - English
• Paid Family Leave – DE 8714CF/S - Spanish
• State Disability Insurance (SDI) Online – DE 8714DI - English
• State Disability Insurance (SDI) Online – DE 8714DI/S - Spanish
• State Disability Insurance Bookmark
  • DE 8717DI - English

Disability Insurance Forms and Publications