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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When calling via the California Relay Serviceplease provide the Paid Family Leave number to the operator. Visit Online Forms and Publications and order a form online. First and last name. The EDD fofm 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.

Any discrepancies or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes. 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.

Complete all sections of the DE FP and submit no later than 41 days from the fodm you wish to begin your bonding claim.


Authorization and Statement of Care: A properly completed application will include: 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. No additional documentation is required.

If you are a woman currently receiving Disability Insurance pregnancy-related benefits, it is not 2510f to request a Claim for Paid Family Leave Benefits. If you have not received this form within 10 days after your disability claim ends, please call Visit an SDI Office.

A form will be mailed to you. The web pages currently in English on the EDD 250f are the official and accurate source for the program information and services the EDD provides.

New mothers transitioning from a Disability Insurance DI -related pregnancy claim to bonding: Last date you worked your regular duties and hours or date you began working at modified duty or less than full duty. Mail your 250f 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.

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

It cannot be downloaded or reproduced. Forms and Publications Labor Market Information. Be sure to write clearly in the spaces provided, use black ink only, and sign the form. Make sure to put a stamp on the envelope. California Driver License number.


To submit by US mail you must first order a claim form. For those forms, visit the Online Forms and Publications section.

Paid Family Leave – Forms and Publications

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

Do not submit duplicates of the same claim. If any questions arise 5201f to the information contained in the translated website, please refer to the English version. You may need to download the free Adobe Reader to view and print linked documents.

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

5201f To order an original form, visit Online Forms and Publicationsor call Some forms and publications are translated by the department in other languages. Follow the steps below to properly submit a PFL claim by mail. Inquiries about individual claims using this form will not be answered. For faster processing, use SDI Online to file your claim. Please note that your employer will be notified that you have submitted a PFL claim.

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