Paid Family Leave Forms
Paid Family Leave Claim Form
Claim for Paid Family Leave (PFL) Benefits - An original form must be submitted by claimants. It cannot be downloaded or reproduced. If you are a woman currently receiving SDI 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. If you have not received this form within 10 days after your disability claim ends please contact us at the telephone number below.
Note: A new version of the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) is available. Effective July 1, 2015, only the new version Rev. 1 (7-14) will be accepted, and we will no longer accept the old version of this form (12-03).
To order a Claim Form for Paid Family Leave Benefits form (DE 2501F), visit Online Forms and Publications or call 1-877-238-4373. Deaf, speech impaired and hard of hearing callers can contact PFL directly by Teletypewriter (TTY) 1-800-445-1312 (this number does not accept voice calls).
- For an example of a properly completed Claim for Paid Family Leave (PFL) Benefits Form DE 2501F for individuals claiming benefits to provide care or bond, see the sample claim form.
Report of Voluntary Plan Family Leave (VPFL) Claim - DE 2523F.