Physician/Practitioner’s – Forms and Publications

Forms

  • Claim for Disability Insurance (DI) Benefits
    • DE 2501 – Rev. 78 (4-12)
      To submit the DE 2501 electronically, complete a one-time registration to establish an online account. To register, go to the SDI Online page and select SDI Online Registration. Once the registration is complete, you may log in and complete your claim by visiting the SDI Online Login page.

      To order a hardcopy claim form, use the Online Forms and Publications page or call 1-800-480-3287 or 1-866-658-8846 (en español). Bulk orders must be submitted through our Online Forms and Publications page. Deaf, speech impaired, and hard of hearing callers can contact DI directly by Teletypewriter (TTY) 1-800-563-2441.
  • Claim for Paid Family Leave (PFL) Benefits

    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.

  • Request for Continued Benefits – Physician/Practitioner’s Supplementary Certificate
    • DE 2525XX – Rev. 3 (1-12)
      To order a hardcopy claim form, call 1-800-480-3287 or 1-866-658-8846.
  • Medical Examiner Information
  • State of California Department of Finance PAYEE DATA RECORD

Publications

To view and print DI and PFL forms and publications, visit the Online Forms and Publications page. Claim forms may be ordered by calling DI at 1-800-480-3287 or PFL at 1-877-238-4373.

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