DE 2501F PDF

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When calling via the California Relay Serviceplease provide the Paid Family Leave se to the operator. Any discrepancies or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes.

These brochures may be downloaded and provided as official notices to employees. To order an original form, visit Online Forms and Publicationsor call All are available free of charge, whether you download or order for delivery by mail.


You may need to download the free Adobe Reader to view and print linked documents. For those 2501c, visit the Online Forms and Publications section.

New Paid Family Leave (PFL) Benefits Form Required July 1 –

To submit by US mail ve must first order a claim form. Deaf, speech impaired, and hard xe hearing callers can contact PFL directly by Teletypewriter TTY this number does not accept voice calls. To request general program information or data about State Disability Insurance, complete the State Disability Insurance Request for Information Form DE E and return it to the Employment Development Department using the appropriate email address listed on the form.

If you have not received this form within 10 days after your disability claim ends, please call It cannot be downloaded or reproduced. PFL law requires employers to provide the Paid Family Leave – DE brochure only to new employees and employees who request leave to care for a seriously ill family member or bond with a new child.

The EDD is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information or changes in the formatting of the pages resulting from the translation application tool.


If you are a woman currently receiving Disability Insurance pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits.

Employers are not required to provide the PFL claim forms to their employees.

Inquiries about individual claims using this form will not be answered. The web pages currently in English on the EDD website are the official and accurate source for the program information and services the EDD provides.

Paid Family Leave – Forms and Publications

Forms ed Publications Labor Market Information. Some forms and publications are translated by the department in other languages. If any questions arise related to the information contained in the translated website, please refer to the English version.