Get De 2504re

Completing the De 2504re form is a crucial step for those seeking to re-establish a bonding claim for paid family leave. This guide provides clear and detailed instructions to help users successfully fill out the form online.

Follow the steps to effectively fill out your De 2504re form.

1. Click ‘Get Form’ button to access the De 2504re form and open it in your editing interface.
2. Enter your social security number (SSN) in the designated field.
3. Fill in your claim effective date (CED) in the appropriate space.
4. Specify the mailing date by entering the current date in the provided field.
5. In the first section, certify that you are taking time off work to bond with your child by entering the child's name.
6. Input your child's date of birth in the corresponding field.
7. Request your benefits to begin by entering the desired start date.
8. Indicate your last day worked and the projected end date for your leave.
9. If applicable, indicate if you will work part-time during this period and select 'Yes' or 'No.'
10. Specify whether you will receive any wages from your employer(s) and detail the type of pay if applicable.
11. Answer whether you have claimed or plan to claim workers’ compensation benefits related to your PFL claim.
12. Indicate if you have more than one employer.
13. Select 'Yes' or 'No' if you have been in custody of law enforcement during your benefits receipt.
14. Provide information about your most recent employer, including name, address, city, state, and zip code.
15. Sign and date the form, certifying the statements you've made to be true and authorizing your employer(s) to disclose relevant facts.
16. After completing the form, ensure to save any changes, then download, print, or share the form as needed.

Start filling out your De 2504re form online today to ensure your benefits are processed smoothly.