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14 Page one of the Claim for Paid Family Leave (PFL) Care Benefits, DE 2501FC, includes the Statement of Care Recipient. After printing this form, complete all fields and have the care recipient sign. 15 Page two of the Claim for Paid Family Leave (PFL) Care Benefits, DE 2501FC, is the Care Recipient Authorization for Disclosure of Personal Health Information. The care recipient needs to sign the bottom of this page. 16 Page three is the Physician/Practitioner s Certification. Make su.

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Related content

DE2501F - Claim for Paid Family Leave (PFL)...
Sep 27, 2004 — information as stated in the “Information Collection and Access”...
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To request PFL, the employee requesting PFL must complete Part A of the Request For Paid Family Leave (Form PFL-1). All items on the form are required unless noted as optional. The employee then provides the form to the employer to complete Part B.

Visit Online Forms and Publications and order a form online. A form will be mailed to you. Obtain the form from your physician/practitioner or employer. Visit an SDI Office. Call 1-877-238-4373. California Relay Service (711) Provide the PFL number (1-877-238-4373)

Once a properly completed claim application is received, the EDD usually determines eligibility within 14 days.

If you prefer, you can also file your PFL claim by mail, although it will take longer to process. You can file your claim as early as nine days before your leave starts or as late as 49 days after your leave starts. However, if you miss the 49-day deadline, you will lose your right to collect benefits.

Go to matrixeservices.com to file a claim. Or, if you don't have Internet access, you can call 1.866. 533.3438. Information You Will Need to Report a Leave of Absence Depending on the type of leave, you will be asked to provide some basic information.

If you want to cancel your claim, contact the EDD IMMEDIATELY. You cannot cancel a claim after you have collected UI benefits and cannot file a new UI claim until your current claim ends. If you go back to work or are no longer in need of UI benefits for some period of time, simply stop certifying.

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Paid Family Leave (PFL) provides working Californians up to eight weeks of partial pay to take time off work to care for a seriously ill family member, bond with a new child, or participate in a qualifying military event.

One who receives care; an individual with a medical condition or who requires support with activities of daily living and is in a relationship with a caregiver, such as a doctor, nurse, friend, or family member, who provides treatment, assistance, or comfort (National Alliance for Caregiving & AARP.

To stop your benefits, notify the EDD using AskEDD, by mail, or by calling 1-877-238-4373. If you are on automatic payment, fill out the Notice of Change in Claimant Status on the Notice of Automatic Payment PFL (DE 2587F) and return it to the EDD.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232