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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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This will delay claim processing. For faster processing, use SDI Online to file your claim. Visit Online Forms and Publications and order a form online.

Paid Family Leave – Forms and Publications

Last date you worked your regular duties and hours or date you began working at modified duty or less than full duty. California Driver License number. Some forms and publications are translated by the department in other languages. 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.

2501 Be sure to write clearly in the spaces provided, use black ink only, and sign the form. These brochures may be downloaded and provided as official notices to employees. All other claimants filing for bonding forj care claims: 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.

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Box West Sacramento, CA A form will be mailed to you. 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.

Paid Family Leave – Forms and Publications

If 251f questions arise related to the information contained in the translated website, please refer to the English version. Do not submit duplicates of the same claim.

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. Provide the information below ONLY if it applies to you: You may mail it with your paper form or scan and upload it to your computer to submit with your claim using SDI Online.

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

New mothers transitioning from a DI-related pregnancy claim to bonding: You may need to download the free Adobe Reader to view and print linked documents. To submit the claim, mail the completed paper claim form to the EDD in the pre-addressed envelope to:.

To request general program information or data about State Disability Insurance, complete the State Disability Insurance Request for Information Form DE E and fork it to the Employment Development Department using the appropriate email address listed on the form.

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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. Please note that your employer will be notified that you have submitted a PFL claim. Forms and Publications Labor Market Information.

No additional documentation is required. Make sure to put a stamp on the envelope. However, your medical information is confidential and will not be shared with your employer. Forms and Publications Labor Market Information.

Complete all sections of the DE FP and submit no later than 41 days from the date you wish to begin your bonding claim. For those forms, visit the Online Forms and Publications section. When calling via the California Relay Serviceplease provide the Paid Family Leave number to the operator. Inquiries about individual claims using this form will not be answered.

If any questions arise related to the information contained in the translated website, please refer to the English version. Follow the steps below to properly submit a PFL claim by mail.