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Claim for Paid Family Leave (PFL) Benefits Paid Family Leave (PFL), a workerfunded program, provides benefits to eligible workers who have a full or partial loss of wages due to the need to care for.

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How to fill out the CA DE 2501F online

The CA DE 2501F form is necessary for individuals seeking Paid Family Leave benefits in California. This guide will provide a clear, step-by-step process for filling out the form online, ensuring you understand each section and its requirements.

Follow the steps to successfully complete the CA DE 2501F form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Complete all items on 'Part A - Statement of Claimant.' Fill in your personal information accurately, including your legal name, date of birth, and Social Security number. Make sure to sign box A25.
  3. If you are claiming benefits for bonding, also complete 'Part B - Bonding Certification' and attach a copy of one of the required documents as outlined in box B10.
  4. For care claims, ensure that the care recipient completes and signs 'Part C - Statement of Care Recipient.' If they are unable to do so, an authorized representative may fill this section out.
  5. Next, have the treating physician or practitioner fill out 'Part D - Physician/Practitioner's Certification.' This part must be completed by a licensed physician and requires a personal signature.
  6. If applicable, complete 'Part E - Military Assist Certification.' Attach all necessary supporting documents as specified in the part.
  7. Decide on the start date for your claim, as this may impact your benefit amount. Check the section on benefit amounts for more information.
  8. Place all completed and signed forms in the provided envelope. Be aware that claims are generally processed within 14 days of receipt by the EDD.
  9. Keep a copy of these instructions and the completed forms for your records.
  10. Once completed, you can choose to save changes, download, print, or share the form as needed.

Start filling out your CA DE 2501F form online today to ensure a seamless application experience for your Paid Family Leave benefits.

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For Disability Insurance claims, fill out and sign Part B – Physician/Practitioner's Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patient's disability begins.

To complete forms, you may need to download and save them on the computer, then open them with the no-cost Adobe Reader. To search and order brochures and forms from the EDD, visit Online Forms and Publications. All are available at no cost, whether you download or order for delivery by mail.

To be eligible for PFL benefits, you must: Be unable to do your regular or customary work. Have lost wages due to the need to: Provide care for a seriously ill family member.

You can get a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form by: Ordering a form onlineto have it mailed to you. Getting the form from your licensed health professional or employer. Visiting an SDI Office. Calling 1-800-480-3287 and selecting DI Information option 3 to request a paper form by mail.

Recommended: Log in to your UI Online account and go to the Upload Income Documents for PUA section on the homepage to provide the required documents. If you prefer to mail your documents, write your 10-digit EDD Customer Account Number (EDDCAN) clearly at the top of each page.

Claim for Paid Family Leave (PFL) Benefits (DE 2501F) - English: You must submit an original form provided by the EDD. This form cannot be downloaded or reproduced. This form cannot be downloaded or reproduced. To submit the DE 2501F electronically, visit How to File a Paid Family Leave Claim in SDI Online.

Downloading and Printing The forms are in Portable Document Format (PDF). You may need to download the no-cost Adobe Reader to view and print linked documents.

You can get a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form by: Ordering a form onlineto have it mailed to you. Getting the form from your licensed health professional or employer. Visiting an SDI Office. Calling 1-800-480-3287 and selecting DI Information option 3 to request a paper form by mail.

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