Do not fax the form. •. Mail the completed form to the EDD in the envelope provided. Submit your claim no earlier than the first day your family leave begins but. Get the de f form. Description of form de f. Claim for Paid Family Leave PFL Benefits F PART A STATEMENT OF CLAIMANT CARE OR. Fill De f Form Download, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile with PDFfiller ✓ Instantly ✓ No software.

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No additional documentation is required. Make sure to put a stamp on the envelope.

New mothers transitioning from a Disability Insurance DI -related pregnancy claim to bonding: Follow the steps below to properly submit a PFL claim by mail. California Driver License number.

How to File a Paid Family Leave (PFL) Claim in SDI Online

Some forms and publications are translated by the department in other languages. Be sure to write clearly in the spaces provided, use black ink only, and sign the form. Please note that your employer will be notified that you have submitted a PFL claim.

You may need to download the free Adobe Reader to view and print linked documents. When calling via the Corm Relay Serviceplease provide the Paid Family Leave number to the operator. Complete all sections of the DE FP and submit no later than 41 days from the date you wish to begin your bonding claim.

All are available free of charge, whether you download or order for delivery by mail. Any discrepancies or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes. Mail your claim no earlier than the first day your family leave begins, but no later than 41 days after your family leave begins or you may lose benefits.

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How to File a Paid Family Leave (PFL) Claim in SDI Online

The web pages currently in English on the EDD website are the official and accurate source for the program information and services the EDD provides. Deaf, speech impaired, and hard of hearing callers can contact PFL directly by Teletypewriter TTY this number does not accept voice calls.

PFL law requires employers to provide the Paid Family Leave – DE brochure only to new employees and employees who request leave to care for a seriously ill family member or bond with a new child.

For those forms, visit the Online Forms and Publications section. Mothers without a pregnancy DI claim, new fathers, and foster or adoptive parents will need to provide a Proof of Relationship document with your bonding claim. Provide the information below ONLY if it applies to you: Any discrepancies or differences created in the translation are not binding and have no legal effect forj compliance or enforcement purposes. To request general program information or data about State Disability Insurance, complete the State Disability Insurance Request for Information Form DE E and return it to the Employment Development Department using the appropriate email address listed on the form.

First and last name. These brochures may be downloaded and provided as official notices to employees.

Visit an SDI Office. It cannot be downloaded or reproduced.

Paid Family Leave – Forms and Publications

New mothers transitioning from a DI-related pregnancy claim to bonding: For bonding, parts A, B, and supporting documents. 25001f EDD is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information or changes in the formatting of the pages resulting from the translation application tool. For those forms, visit the Online Forms and Publications section. Forms and Publications Labor Market Information.

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If any questions arise related to the information contained in the 2501r website, please refer to the English version. If you are a woman currently receiving Disability Insurance pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits.

Box West Sacramento, CA To order an original form, visit Online Forms and 2501or call A properly completed application will include: A form will foorm mailed to you. All other claimants filing for bonding or care claims: The EDD is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information or changes in the formatting of the pages resulting from the translation application tool.

Authorization and Statement of Care: This will delay claim processing.

Paid Family Leave – Forms and Publications

However, your medical information is confidential and will not be shared with your employer. To submit the claim, mail the completed paper claim form to the EDD in the pre-addressed envelope to:.

If you have not received this form within 10 days after your disability claim ends, please call Visit Online Forms and Publications and order a form online. Inquiries about individual claims using this form will not be answered. Employers are not required to provide the PFL claim forms to their employees. If any questions arise related to the information contained in the translated website, please refer to the English version.

For faster processing, use SDI Online to file your claim. Do not submit duplicates of the same claim.