Voluntary Plan Forms and Publications

Find important forms, materials, and publications for the Voluntary Plan (VP).

Note: The following documents 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.

Forms

Voluntary Plan Applications

• Application for Approval of Voluntary Plan Self-Insured Disability Benefits (DE 2520BV)
• Notice of Election to Make Voluntary Plan Applicable to All Employees (DE 2520CV)
• Application for Approval of Voluntary Plan for Successor (DE 2041)
• Application for Voluntary Plan Conversion (DE 2520MV)
• Application to Participate in a SBTPA Administered Voluntary Plan (DE 2520AU)
• Small-Business Third-Party Administrator Voluntary Plan Application (DE 2778)

Annual Plan Text Reports

• Plan Text Provisions (DE 2008)

Annual Financial Reports – Due Annually on February 15

• Annual Report of Self-Insured Voluntary Plan Transactions (DE 2568V)

Security Deposit and Updates – Due Annually on April 15

• Voluntary Plan Security Review Worksheet (DE 2544SRW) Note: For full functionality, this form must be downloaded to your computer before completing.
• Guarantee Bond (DE 2544V)
• Agreement Regarding Deposit of Cash (DE 2545V)
• Guarantee Bond for a Small-Business Third Party Administrator (DE 2544VP)
• Model Letter of Credit (DE 2042) (Example)

Contact Forms – Due Annually on June 15

• Voluntary Plan Third-Party Administrator Authorization (DE 2520BV-A)
• Voluntary Plan Third-Party Administrator Administrative Changes (DE 2520BV-B)
• Voluntary Plan Employer Administrative Changes (DE 2520BV-C)

Claim Reporting Forms

• Report of Voluntary Plan Disability Claim (DE 2523)
• Report of Voluntary Plan Family Leave Claim (DE 2523F)

Claim Information

• Disability Insurance and Paid Family Leave Weekly Benefit Amounts (DE 2588)

Tax Reporting

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

• Quarterly Contribution Return (DE 3D)
• Quarterly Contribution Return and Report of Wages (Continuation) (DE 9C)
• Voluntary Plan for Disability Insurance Quarterly Adjustment Form (DE 938) and Instructions (DE 938i)

Publications

• Employer’s Guide to Voluntary Plan Procedures (DE 2040)
• State Disability Insurance Bookmark (DE 8717DI)
• Instructions for Completing the Voluntary Plan for Disability Insurance Quarterly Adjustment Form (DE 938) (DE 938I) and Instructions (DE 938i)

General Release Letters

• General Release Letter for 2024
• General Release Letter for 2023