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Employment Development Department
Employment Development Department

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 May 1, 2015, the old version (12-03) will no longer be accepted.

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).

Report of Voluntary Plan Family Leave (VPFL) Claim - DE 2523F.