This form is a sample letter in Word format covering the subject matter of the title of the form.
Sample Money Order Form For Physicians In California
Category:
State:
Multi-State
Control #:
US-0016LTR
Format:
Word;
Rich Text
Instant download
Description
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FAQ
If you lost or did not receive the DE 2525XX, you can request the form using your SDI Online account or by calling 1-800-480-3287 or 1-866-658-8846 (en espaol).
What form does my doctor have to fill out for disability in California? 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.
State Disability Insurance (“SDI”) is a California state program administered by the Employment Development Department (“EDD”). SDI provides partial wage replacement when workers are unable to perform their regular or customary work due to physical and mental injuries, illnesses, and other health conditions.
You must provide the following information to file a DI claim using SDI Online: Valid California Driver License (CDL) or Identification (ID) card number. Your full legal name as it appears on your CDL or ID. Date of birth as shown on your CDL or ID. Social Security number.
The following licensed health professionals can certify claims: Licensed medical or osteopathic physician/practitioners. Authorized medical officer of a U.S. Government facility. Chiropractor. Podiatrist. Optometrist. Dentist. Psychologist. Nurse practitioner or physician assistant.
If You Need to Extend Your DI Period You will receive a Physician/Practitioner's Supplementary Certificate (DE 2525XX) with your final payment. Have your physician/practitioner complete and submit this form to find out if you are eligible for an extension. Your physician/practitioner can find your claim in SDI Online.
To file your claim online, follow these steps: Log in to your myEDD account. Select SDI Online. Select New Claim. Select Disability Insurance and follow the steps in each section. Choose your payment option when prompted: direct deposit, debit card, or check. Submit the completed Part A – Claimant's Statement.
