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Obtain a paper claim form.
Edd disability insurance form. The documents on this webpage are pdfs. However edd will accept pertinent information from employers regarding an employee s wage and employment status. The california state disability insurance sdi program provides short term disability insurance di and paid family leave pfl wage replacement benefits to eligible workers who need time off work. Health insurance portability and accountability act authorization.
State disability insurance forms and publications. Visit accessibility if you need reasonable accommodation or an alternative format to access information on our website. The pdfs on this website are replicas of the official edd forms and publications. Disability insurance di provides short term benefits to eligible workers who have a full or partial loss of wages due to a non work related illness injury or pregnancy.
Form de 2501 claim for disability insurance di benefits is a form to request by mail worker funded benefits to eligible workers who have a full or partial loss of wages due to disabilities that are not work related. Follow the steps below to properly submit a di claim by mail. You can obtain a paper claim for disability insurance di benefits de 2501 form by. To complete forms you may need to download and save them on the computer then open them with the no cost adobe reader.
The only information edd sdi unit will provide to employers is that a sdi claim has been filed via a de2503 or de 2503f form unless the employee has authorized a release of information to the employer. State disability insurance disability insurance and paid family leave benefits. It cannot be downloaded or reproduced. To file a disability insurance di claim by mail complete and submit a claim for disability insurance di benefits de 2501.
Sdi online is your fast convenient and secure way to submit your disability insurance di and paid family leave pfl claims and forms online. To submit the de 2501 electronically visit how to file a disability insurance claim in sdi online. To complete forms you may need to download and save them on the computer then open them with the no cost adobe reader. Sdi online reduces claim processing time provides online confirmation of submitted forms decreases costs in paper and postage includes security safeguards to detect and manage fraud and abuse and.
Visit online forms and publications to search view and order state disability insurance forms. To avoid stocking outdated forms order a six month supply or less. Visiting online forms and publications and ordering a form online to have it mailed to you.
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