Paid Family Leave - Forms and Publications

En español

The Paid Family Leave law requires employers to provide the Paid Family Leave, DE 2511, brochure only to new employees and employees who request leave to care for a seriously ill family member or bond with a new child. Employers are not required to provide the Paid Family Leave insurance claim forms to their employees.

Employers may download and print the Paid Family Leave, DE 2511 I, brochure (PDF) from the EDD Internet site if they wish to provide the brochure to their new employees without ordering specific supplies from EDD. This method meets the statutory requirement and can be a quick and easy way to meet your immediate needs. To order brochures and forms from EDD, please use the Online Forms and Publications page.

The forms and publications on this website are replicas of the official EDD forms and publications and are in Adobe’s Portable Document Format (PDF). You may need to download the free Adobe Reader to view and print linked documents.

Claim Form

Claim for Paid Family Leave (PFL) Benefits (An original form must be submitted by claimants. It cannot be downloaded or reproduced.)

• DE 2501F (12-03)
  To order a claim form, please use the Online Forms and Publications page, 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.)
• DE 2501F (12-03) – Sample claim form
  An example of a properly completed Claim for Paid Family Leave (PFL) Benefits form for individuals claiming benefits to provide care.
• Nurse Practitioner Certification for Paid Family Leave Benefits, DE 2509F
  If a nurse practitioner is certifying the Claim for PFL Benefits, he/she must complete, print and sign the “Nurse Practitioner Certification for Paid Family Leave Benefits, DE 2509F” and attach it to the claim for PFL benefits, DE 2501F.

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 call 1-877-238-4373.

Publications

Notice to Employees
This poster is required to be posted in the workplace of employees who are covered by Unemployment Insurance and Disability Insurance.

• DE 1857A – Rev. 41 (12-12) - English
• DE 1857A/C – Rev. 41 (12-12) - Chinese
• DE 1857A/S – Rev. 41 (12-12) - Spanish
• DE 1857A/V – Rev. 41 (12-12) - Vietnamese (144k)

Notice to Employees
This poster is required to be posted in the workplace of employees who are covered only by Disability Insurance. If your employees are also covered by Unemployment Insurance, please post the DE 1857A.

• DE 1858 – Rev. 4 (11-08) - English
• DE 1858/S – Rev. 4 (11-08) - Spanish

Paid Family Leave
Employers are required to provide the Paid Family Leave brochure only to new employees and persons who request leave to care for a seriously ill family member or bond with a new child. These brochures may be downloaded and provided as official notices to employees.

• DE 2511 – Rev. 8 (11-12) - English
• DE 2511I – Rev. 8 (11-12) - English - Printer-friendly version
• DE 2511/B – Rev. 8 (11-12) - Cambodian
• DE 2511/C – Rev. 8 (11-12) - Chinese
• DE 2511/K – Rev. 8 (11-12) - Korean
• DE 2511/L – Rev. 7 (1-12) - Laotian
• DE 2511/S – Rev. 8 (11-12) - Spanish
• DE 2511I/S – Rev. 8 (11-12) - Spanish - Printer-friendly version
• DE 2511/T – Rev. 8 (11-12) - Thai
• DE 2511/V – Rev. 8 (11-12) - Vietnamese

The Physician’s/Practitioner’s Guide to Paid Family Leave

• DE 2548F – Rev. 2 (3-13)

Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts

• DE 2588 – Rev. 8 (1-13)

Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts in Dollar Increments

• DE 2589 – Rev. 5 (1-13)

Tip Sheets

• SDI Online Tips for Claimants - DE 8515 - Rev. 1 (2-13) - English
• SDI Online Tips for Physicians and Practitioners - DE 8516 - Rev. 1 (4-13) - English
• SDI Online Tips for Employers - DE 8518 (4-13) - English

Fact Sheet

• Paid Family Leave - DE 8714CF – Rev. 13 (11-12) - English
• Paid Family Leave - DE 8714CF/S – Rev. 13 (11-12) - Spanish
• State Disability Insurance (SDI) Online - DE8714DI – Rev. 1 (3-13) - English
• State Disability Insurance (SDI) Online - DE8714DI/S – Rev. 1 (3-13) - Spanish