Voluntary Plan Forms and Publications
The documents on this website are PDFs. To complete the forms, you may need to download and save the forms on your computer. You can open the documents 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
Annual Financial Reports – Due Annually on February 15
- Annual Report of Self-Insured Voluntary Plan Transactions (DE 2568V) Note: For full functionality, this form must be downloaded to your computer before completing.
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
You can submit these forms online with SDI Online
- Report of Voluntary Plan Disability Claim (DE 2523)
- Report of Voluntary Plan Family Leave Claim (DE 2523F)
Claim Information
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)
General Release Letters