Disability Insurance - Forms and Publications
Use the links on this page to access informational forms and materials for Disability Insurance. To search and order brochures and forms from the EDD, visit Online Forms and Publications. All are available free of charge, whether you download or order for delivery by mail.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 for Disability Insurance (DI) Benefits (DE 2501) - English
An original form provided by the EDD must be submitted by claimants. It cannot be downloaded or reproduced.
- DE 2501 – Sample claim form
An example of a Claim for Disability Insurance (DI) Benefits form for individuals claiming disability benefits.
- DE 2501S – Spanish sample claim form - Spanish
An example in Spanish of a Claim for Disability Insurance (DI) Benefits form for individuals claiming disability benefits.
To submit the DE 2501 electronically, visit the Benefit Programs Online (BPO) login page and select Register to get started creating an account now. After you have registered for and logged in to BPO, select SDI Online which will direct you to the SDI Online Registration Options. Once your registration is complete, log in to BPO and select SDI Online to be directed to your Home page to file your claim.
To submit by US mail you must first order a claim form. To order an original form, visit Online Forms and Publications or call 1-800-480-3287 or 1-866-658-8846 (en español).
Deaf, speech impaired, and hard of hearing callers can contact the EDD by Teletypewriter TTY: 1-800-563-2441 (This number does not accept voice calls.) When calling via the California Relay Service (711), please provide the Disability Insurance number (1-800-480-3287) to the operator.
- 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 by accessing 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 Employment Development Department using the appropriate email address listed on the form.
Note: Inquiries about individual claims using this form will not be answered.
Note: If your printer has a problem printing the above form, try the “Shrink to Fit” check box under the Acrobat Reader’s print function.
- 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
- SDI Online Flyer
- SDI Online Poster
- Nonindustrial Disability Insurance Provisions
- DE 8502 - English
- SDI Online Bookmark for Claimants
- State Disability Insurance Bookmark
- Tip Sheets
- 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 – DE8714DI - English
- State Disability Insurance (SDI) Online – DE8714DI/S - Spanish