How to File a Paid Family Leave Claim by Mail
To file a Paid Family Leave (PFL) claim by mail, complete and submit a Claim for Paid Family Leave (PFL) Benefits (DE 2501F). Follow the steps below to properly submit a PFL claim by mail.
1. Obtain a Paper Claim Form
You can obtain a paper Claim for Paid Family Leave (PFL) Benefits (DE 2501F) form a few different ways:
- Visit Online Forms and Publications and order a form online. A form will be mailed to you.
- Obtain the form from your physician/practitioner or employer.
- Visit an SDI Office.
- Call 1-877-238-4373.
New mothers transitioning from a Disability Insurance (DI)-related pregnancy claim to bonding: When you have recovered from delivering your baby, a Claim for Paid Family Leave (PFL) Benefits – New Mother (DE 2501FP) will be automatically mailed to you in a separate envelope at the same time your final DI payment is issued.
2. Gather Required Information
You must provide the following information to file a PFL claim:
- First and last name.
- Social Security number.
- California Driver License number.
- Most current employer’s business name, phone number, and mailing address (as stated on your W-2 or paystub).
- Last date you worked your regular duties and hours or date you began working at modified duty or less than full duty.
Provide the information below ONLY if it applies to you:
- Any wages you received or expect to receive from your employer (sick leave, paid-time-off [PTO], vacation pay, annual leave, and wages earned after you stopped working).
3. Complete Claim for Benefits
New mothers transitioning from a DI-related pregnancy claim to bonding: Complete all sections of the DE 2501FP and submit no later than 41 days from the date you wish to begin your bonding claim. No additional documentation is required.
All other claimants filing for bonding or care claims: Complete Part A, Claimant’s Statement (page 1), of the DE 2501F form. Be sure to write clearly in the spaces provided, use black ink only, and sign the form.
- Bonding Certification: Also complete Part B, Bonding Certification (page 2) of the DE 2501F form.
- Proof of Relationship: Mothers without a pregnancy DI claim, new fathers, and foster or adoptive parents will need to provide a Proof of Relationship document with your bonding claim. You may mail it with your paper form or scan and upload it to your computer to submit with your claim using SDI Online.
- Authorization and Statement of Care: You must obtain the Care Recipient’s Authorization for Disclosure of Personal Health Information and Part C - Statement of Care Recipient of the DE 2501F, signed by the care recipient or their authorized representative.
- Physician/Practitioner’s Certification: You also need Part D - Physician/Practitioner’s Certification of the Claim for Paid Family Leave (PFL) Benefits (DE 2501F) completed and signed by the care recipient’s physician/practitioner. The physician/practitioner may submit the certification using SDI Online or they can complete and sign the paper form.
For bonding claims:
For care claims:
Note: If the physician/practitioner wishes to submit Part D – Physician/Practitioner’s Certificate using SDI Online, allow five business days for the EDD to receive and process your claim.
After your paper claim has been received, your physician/practitioner may search for your claim in SDI Online using the last four digits of your Social Security number, last name, and date of birth.
It is your responsibility to have the physician/practitioner complete and sign the form and submit it to the EDD within 49 days from the date your family leave begins or you may lose benefits.
For more information, review the Guide for Completing a Claim Form for Paid Family Leave Benefits.
For line by line instructions visit our Paid Family Leave – Manual Forms page.
4. Mail the Completed Claim for Paid Family Leave (PFL) Benefits (DE 2501F)
To submit the claim, mail the completed paper claim form to the EDD in the pre-addressed envelope to:
State of California
Employment Development Department
P.O. Box 989315
West Sacramento, CA 95798-9315
- Make sure to put a stamp on the envelope.
- Mail your claim no earlier than the first day your family leave begins, but no later than 41 days after your family leave begins or you may lose benefits.
- For faster processing, use SDI Online to file your claim.
- Do not submit duplicates of the same claim. This will delay claim processing.
- A properly completed application will include:
- For bonding, parts A, B, and supporting documents.
- For care, parts A, C, D, and the Care Recipient’s Authorization for Disclosure of Personal Health Information.
- Please note that your employer will be notified that you have submitted a PFL claim. However, your medical information is confidential and will not be shared with your employer.