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Na que recibe cuidado (la persona a la cual usted le provee cuidado) debe hacer lo siguiente: Completar y firmar la Parte C Declaraci n de la Persona que Recibe Cuidado . Si la persona que recibe cuidado se encuentra f sica o mentalmente imposibilitada para firmar, llame al PFL al 1-877-238-4373 para recibir instrucciones. El m dico/profesional m dico de la persona que recibe cuidado debe completar la Parte D del formulario, la cual se titula en ingl s Part D Physician.

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How to fill out the CA DE 2501FC/S online

Completing the CA DE 2501FC/S form online is an essential step for individuals seeking Paid Family Leave benefits in California. This guide provides straightforward instructions for filling out each section of the form, ensuring that you can navigate the process with ease.

Follow the steps to fill out the CA DE 2501FC/S form efficiently.

  1. Click ‘Get Form’ button to obtain the form and open it for editing.
  2. Enter the receipt number in the designated field at the top of the form.
  3. In Part C – Declaration of the Person Receiving Care, the recipient must complete and sign this section. If they are unable due to physical or mental limitations, you can contact the Paid Family Leave office at 1-877-238-4373 for further instructions.
  4. The physician or authorized medical professional must fill out Part D. They should either complete the certification online or sign the specified page of the form.
  5. If the recipient of care is under the care of a religious practitioner, contact the Paid Family Leave office for the correct form. Ensure that all necessary authorizations and signatures are included.
  6. Provide complete information for all fields, including Social Security numbers, dates of birth, and medical certifications.
  7. Confirm that all information is accurate before submitting the form. You can option to save changes, download, print, or share the form once completed.

Complete your CA DE 2501FC/S form online today for a smoother application process.

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Related content

DE 2501F - EDD - CA.gov
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Claim for Paid Family Leave (PFL) Care Benefits...
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Visit EDD Forms and Publications (edd.ca.gov/Forms) to request a Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form. For caregiving claims, you must provide medical certification showing that the care recipient has a serious health condition and requires your care.

These forms are typically available in printable format on the EDD website and must be completed and submitted by the individuals receiving benefits.

After you file for PFL, the process can take a few weeks while the EDD reviews your application. Provide confirmation of your weekly benefit rate to your employer or leave and claims administrator.

Claim for Disability Insurance (DI) Benefits (DE 2501) – English: You must submit an original form provided by the EDD, either electronically or through US mail. It cannot be downloaded or reproduced.

To be eligible for family leave pay in California, employees must have earned $300 or more in wages during a 12-month base period preceding the claim. These wages must have been subject to withholdings for the state's disability insurance program.

You can get a paper Claim for Disability Insurance (DI) Benefits (DE 2501) form by: Ordering a form online to have it mailed to you. Getting the form from your physician/practitioner or employer. Visiting an SDI Office. Calling 1-800-480-3287 to request a paper form by mail.

PFL pays approximately 60% of current earnings up to a maximum of $1,620 per week in 2024. The other 40% will be paid with accrued sick hours for non-baby bonding claims.

Submit Form DE 2501F Claim for Paid Family Leave (PFL) Benefits, informing. the EDD that you plan to use your benefits intermittently. You can apply for PFL online or by mail. To view a tutorial on how to apply for PFL online, visit SDI Online Tutorial: File a Paid Family Leave Claim.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
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
altaFlow
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 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232