Disability Insurance – Forms and Publications
The documents on this website are PDFs. To complete forms, you may need to download and save them on the computer, then open them with the no-cost Adobe Reader.
To search and order brochures and forms from the EDD, visit Online Forms and Publications. All are available at no cost, whether you download or order for delivery by mail.
- Claim for Disability Insurance (DI) Benefits (DE 2501) – English:
You must submit an original form provided by the EDD, either electronically or through US mail. It cannot be downloaded or reproduced.
To submit the DE 2501 electronically, visit How to File a Disability Insurance Claim in SDI Online.
To submit by US mail, visit How to File a Disability Insurance Claim by Mail.
- DE 2501 – Sample claim form: An example of a Claim for Disability Insurance (DI) Benefits form for individuals claiming disability benefits.
- DE 2501/S – Spanish sample claim form - Spanish: An example in Spanish of a Claim for Disability Insurance (DI) Benefits form for individuals claiming disability benefits.
- First Claim for Nonindustrial Disability Insurance (DE 8501): Disability claim form for excluded state employees.
- If you are under the care of an accredited religious practitioner, you can download and print this form. Have your religious practitioner complete and sign the Claim for Disability Insurance Benefits – Religious Practitioner’s Certificate (DE 2502) before sending it to the EDD. A licensed physician or practitioner cannot complete this form.
- Declaration of Individual Claiming Benefits Due an Incapacitated or Deceased Claimant (DE 2522): Form to claim benefits on behalf of a deceased or incapacitated claimant.
- Physician/Practitioner’s Supplementary Certificate (DE 2525XX): If your disability will extend beyond the original period established on your claim, have your physician/practitioner complete and submit the DE 2525XX online using SDI Online. To submit by US mail, you must first order the form by calling 1-800-480-3287 or 1-866-658-8846 (en español).
- Annual Income Report for Disability Insurance Elective Coverage (DE 945).
- Application for Disability Insurance Elective Coverage (DE 1378DI).
To request general program information or data about State Disability Insurance, complete the State Disability Insurance Request for Information Form (DE 2541E) and return it to the EDD using the appropriate email address listed on the form. If your printer has a problem printing the form, try the Shrink to Fit check box under the Acrobat Reader’s print function.
Note: Questions about individual claims using this form will not be answered.
- Appeal Fact Sheet
- Notice to Employees
- Notice to Employees
(Employers Note: This poster is required to be posted in the workplace of employees who are covered only by Disability Insurance. If your employees are covered by Unemployment Insurance, please post the DE 1857A.)
- Disability Insurance Provisions - To order forms, please use the Online Forms and Publications page.
- Important Information for Disability Insurance (DI) Claimants
- Physician/Practitioner’s Guide to Disability Insurance Online Forms and Publications page.
- Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts
- Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts in Dollar Increments
- SDI Online Brochure for Physicians/Practitioners
- Nonindustrial Disability Insurance Provisions
- DE 8502 - English
- Tip Sheets
- Transitioning from Disability Insurance to Paid Family Leave
- Fact Sheets
- Disability Insurance Program – DE 8714C - English
- Disability Insurance Program – DE 8714C/A - Armenian
- Disability Insurance Program – DE 8714C/CC - Chinese-Cantonese
- Disability Insurance Program – DE 8714C/CM - Chinese-Mandarin
- Disability Insurance Program – DE 8714C/P - Punjabi
- Disability Insurance Program – DE 8714C/S - Spanish
- Disability Insurance Program – DE 8714C/T - Tagalog
- Disability Insurance Program – DE 8714C/V - Vietnamese
- Disability Insurance Elective Coverage Program – DE 8714CC - English
- State Disability Insurance (SDI) Online – DE 8714DI - English
- State Disability Insurance (SDI) Online – DE 8714DI/S - Spanish
- SDI Online Bookmark for Claimants
- State Disability Insurance Bookmark