How to File a Paid Family Leave (PFL) Claim by Mail

You can get a paper Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form by:

• Ordering a form online to have it mailed to you within ten days.
• Getting the form from your licensed health professional or employer.
• Visiting an SDI Office.
• Calling 1-877-238-4373 to request a paper form be mailed to you. California Relay Service (711) – Provide the PFL number (1-877-238-4373)

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.
• Most current employer’s business name, phone number, and mailing address (as stated on your W-2 or paystub).
• Last date you worked your regular duties and hours or date you began working at modified duty or less than full duty.

Provide the information below ONLY if it applies to you:

• Any wages you received or expect to receive from your employer (sick leave, paid-time-off [PTO], vacation pay, annual leave, and wages earned after you stopped working).

New mothers transitioning from a DI-related pregnancy claim to bonding: Complete all sections of the Claim for Paid Family Leave (PFL) Benefits – New Mother (DE 2501FP) and submit no later than 41 days from the date you wish to begin your bonding claim. No additional documentation is required.

Claimants filing bonding, care, or military assist claims: Complete Part A, Claimant’s Statement (page 1), of the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form.

For bonding claims:

• Bonding Certification: Also complete Part B - Bonding Certification (page 2) of the DE 2501F form.
• Proof of Relationship: Mothers without a pregnancy DI claim, new fathers, and foster or adoptive parents will need to provide a Proof of Relationship document with your bonding claim. You may mail it with your paper form.

For care claims:

• Statement of Care: You must complete Part C - Statement of Care Recipient (page 3) of the DE 2501F, and have it signed by the care recipient or their authorized representative.
• Physician/Practitioner’s Certification: You also need Part D - Physician/Practitioner’s Certification (page 4) of the DE 2501F completed and signed by the care recipient’s licensed health professional. The licensed health professional may submit the certification using SDI Online or they can complete and sign the paper form. 

Note: If the licensed health professional 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 licensed health professional 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 the licensed health professional 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.

For military assist claims:

• Military Certification: You must complete Part E - Military Assist Certification (page 5) and the Qualifying Event for Leave (page 6) of the PFL claim form.
• Your claim must have supporting military documentation, including:
• Covered active duty orders.
• Letter of impending call or order to covered active duty.
• Documentation of military leave signed by the approving authority for the military member's rest and recuperation.
• Qualifying event documentation must also be provided, 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.

Speak to your employer regarding eligible qualifying events.

For more information, review the Guide for Completing a Claim Form for Paid Family Leave Benefits (PDF).

To submit the claim, mail the completed paper claim form to us in the pre-addressed envelope to:

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

Important Tips

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.