Paid Family Leave – Forms and Publications

The documents on this website are PDFs. To complete forms, you may need to download and save them on your computer, then open them with the no-cost Adobe Reader.

Note: Paid Family Leave (PFL) law requires employers to provide the Paid Family Leave (DE 2511) brochure to new employees, employees who request leave to care for a seriously ill family member or bond with a new child, or employees who participate in a qualifying event due to an eligible family member’s military deployment.

To search and order EDD brochures and forms, visit Online Forms and Publications. All are available at no cost and can be downloaded or delivered by mail.

Forms

• 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. To submit the DE 2501F by US mail, visit How to File a Paid Family Leave Claim by Mail.

• Visit Online Forms and Publications.
• Select Keyword(s) or Form Number from the dropdown.
• Enter DE 2501F for an English form or DE 2501F/S for a Spanish form.
• Select Search.
• You can also call 1-877-238-4373 and select Option 3.

To view an example PFL claim form, review the DE 2501F – Sample claim form.

• Claim for Paid Family Leave (PFL) Care Benefits (DE 2501FC): If you submit your PFL claim electronically, you must submit the DE 2501FC to complete your claim, which includes the care recipient’s authorization and the physician/practitioners certification. To submit the DE 2501FC electronically, go to SDI Online.

• Claim for Nonindustrial Disability Insurance - Family Care Leave (NDI-FCL) (DE 8501F): Family leave claim form for excluded state employees.

• If you are under the care of an accredited religious practitioner, you can download and print this form. Have your religious practitioner complete and sign the Practitioner’s Certification for Paid Family Leave (PFL) Benefits (DE 2502F) before sending it to the EDD. A licensed health professional cannot complete this form.
• Request to Re-establish a Bonding Claim for Paid Family Leave (DE 2504RE): To submit the DE 2504RE electronically, go to SDI Online.
• Declaration of Claimant (Care Provider) Acting as Authorized Representative for Incapacitated or Deceased Care Recipient (DE 1850J): Form to authorize a representative for a deceased or incapacitated person to establish eligibility for PFL benefits. Declaration of Claimant (Care Provider) Acting as Authorized Representative for Incapacitated or Deceased Care Recipient (DE 1850J)
• Declaration of Individual Claiming Benefits Due an Incapacitated or Deceased Claimant (DE 2522/DE 2522J): Form to claim benefits on behalf of a deceased or incapacitated claimant.

Note: If you are currently receiving Disability Insurance pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits. You will automatically be sent a Claim for Paid Family Leave (PFL) Benefits New Mother (DE 2501FP) when your pregnancy-related disability claim ends. Complete the DE 2501FP to receive PFL bonding benefits.

Note: English version claim forms cannot be downloaded or reproduced. Spanish claim forms are provided in a downloadable version and may be filled out and printed.

Publications

• Appeal Fact Sheet
  • DE 1001
  • DE 1857A - English
  • DE 1857A/A - Armenian
  • DE 1857A/CC - Cantonese
  • DE 1857A/CM - Mandarin
  • DE 1857A/P - Punjabi
  • DE 1857A/S - Spanish
  • DE 1857A/T - Tagalog
  • DE 1857A/V - Vietnamese
  • DE 1858 - English
  • DE 1858/S - Spanish
  • DE 2475 - English
  • DE 2475/A - Armenian
  • DE 2475/CC - Chinese-Cantonese
  • DE 2475/CM - Chinese-Mandarin
  • DE 2475/P - Punjabi
  • DE 2475/S - Spanish
  • DE 2475/T - Tagalog
  • DE 2475/V - Vietnamese
  • DE 2508 - English and Spanish
  • DE 2511D - English (Digital)
  • DE 2511D/A - Armenian (Digital)
  • DE 2511D/CC - Chinese-Cantonese (Digital)
  • DE 2511D/CM - Chinese-Mandarin (Digital)
  • DE 2511D/K - Korean(Digital)
  • DE 2511D/P - Punjabi (Digital)
  • DE 2511D/S - Spanish (Digital)
  • DE 2511D/T - Tagalog (Digital)
  • DE 2511D/V - Vietnamese (Digital)
  • DE 2515PF
  • DE 2548FD
  • DE 2550 - English
  • DE 2550/A – Armenian
  • DE 2550/CC – Chinese-Cantonese
  • DE 2550/CM – Chinese-Mandarin
  • DE 2550/K– Korean
  • DE 2550/S– Spanish
  • DE 2550/P– Punjabi
  • DE 2550/T– Tagalog
  • DE 2550/V- Vietnamese
  • DE 2588
  • DE 2589
  • DE 8502FD - English digital version
  • SDI Online Tips for Claimants - DE 8515 - English
  • SDI Online Tips for Claimants - DE 8515/S - Spanish
  • SDI Online Tips for Licensed Health Professionals - DE 8516 - English
  • SDI Online Tips for Employers - DE 8518 - English
  • DE 8520 - English
  • DE 8519 - English
  • DE 8519/A - Armenian
  • DE 8519/CC - Chinese-Cantonese
  • DE 8519/CM - Chinese-Mandarin
  • DE 8519/P - Punjabi
  • DE 8519/S - Spanish
  • DE 8519/T - Tagalog
  • DE 8519/V - Vietnamese
  • DE 8521 - English
  • DE 8521/A - Armenian
  • DE 8521/CC - Chinese-Cantonese
  • DE 8521/CM - Chinese-Mandarin
  • DE 8521/K - Korean
  • DE 8521/P - Punjabi
  • DE 8521/T - Tagalog
  • DE 8521/V - Vietnamese
  • DE 8717DI - English