Online Forms

Instructions on Completing the Online Claim for SDI Benefits, DE 2501

1. Place your cursor in the form field for question 1, type your answer.
2. Navigate through the remainder of the form by using your Tab key. Check boxes require that you use your mouse to click the appropriate box(es).
3. Within the form itself, you will find some direction telling you either to complete certain questions or to skip some questions depending on your response to the question you are currently answering.
4. Review your answers to be sure your answers are correct and complete.
5. Use your Internet browser's print function to print your completed claim (four 8-1/2“ x 11” pages). (Without special software, you will not be able to electronically save the claim form along with the information you entered. Therefore, you may wish to print it twice so that you have a copy for your records.)
6. Place your signature in both “Claimant’s Signature” spaces in both Item 31 and Item 32 and print the date in the “Date Signed” spaces in both items. If you prefer to complete a Health Insurance Portability and Accountability Act (HIPAA) Authorization in large print, you may also complete, sign, and date page 4.
7. To avoid loss of benefits, your claim must be postmarked no earlier than 9 days but no later than 49 days after you became disabled.

   Mail or bring your claim (completed, signed “Claim Statement of Employee” plus the blank “Doctor's Certificate”) to your doctor for completion of the “Doctor's Certificate” portion of your claim.

   If your doctor will mail your completed claim to SDI, provide them with an envelope addressed to the DI office that is nearest to your residence.