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Paid Family Leave - Forms and Publications

En Español

The Paid Family Leave law requires employers to provide the Paid Family Leave, DE 2511, brochure only to new employees and employees who request leave to care for a seriously ill family member or bond with a new minor child. Employers are not required to provide the Paid Family Leave insurance claim forms to their employees.

Employers may download and print the Paid Family Leave, DE 2511 I, brochure (PDF) from the EDD Internet site if they wish to provide the brochure to their new employees without ordering specific supplies from EDD. This method meets the statutory requirement and can be a quick and easy way to meet your immediate needs. To order brochures and forms from EDD, please use our Internet Order form.

The forms and publications on this Web site 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 Form

• Claim for Paid Family Leave (PFL) Benefits ( An original form must be submitted by claimants. It cannot be downloaded or reproduced.)
  
  • DE 2501F (12-03)
    To order a single claim form, please use Request a Claim Form for Paid Family Leave Benefits, or call 1-877-238-4373. For bulk orders, please use the Internet Order Form for EDD Forms and Publications. Deaf, speech impaired, and hard of hearing callers can contact PFL directly by Teletypewriter (TTY) 1-800-445-1312 (this number does not accept voice calls.)
  • DE 2501F (12-03) - Sample claim form
    An example of a properly completed Claim for Paid Family Leave (PFL) Benefits form for individuals claiming benefits to provide care.
    
    If you are a woman currently receiving SDI pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits. You will automatically be sent a Claim for Paid Family Leave (PFL) Benefits - New Mother, DE 2501FP, when your pregnancy-related disability claim ends.
    
    If you have not received this form within 10 days after your disability claim ends please call 1-877-238-4373.

Publications

• Notice to Employees
  This poster is required to be posted in the workplace of employees who are covered by Unemployment Insurance and Disability Insurance.
  • DE 1857A - Rev. 39 (11-08) - English
  • DE 1857A/C/ - Rev. 39 (11-08) - Chinese
  • DE 1857A/S/ - Rev. 39 (11-08) - Spanish
  • DE 1857A/V/ - Rev. 39 (11-08) - Vietnamese (144k)
• Notice to Employees
  This poster is required to be posted in the workplace of employees who are covered only by Disability Insurance. If your employees are also covered by Unemployment Insurance, please post the DE 1857A.
  • DE 1858 - Rev. 4 (11-08) - English
  • DE 1858/S/ - Rev. 4 (11-08) - Spanish
• Paid Family Leave
  Employers are required to provide the Paid Family Leave brochure only to new employees and persons who request leave to care for a seriously ill family member or bond with a new minor child. These brochures may be downloaded and provided as official notices to employees.
  • DE 2511 - Rev. 6 (8-09) - English
  • DE 2511I - Rev. 5 (1-09) - English - Printer-friendly version
  • DE 2511/B - Rev. 5 (1-08) - Cambodian
  • DE 2511/C - Rev. 6 (1-09) - Chinese
  • DE 2511/K - Rev. 5 (1-08) - Korean
  • DE 2511/L - Rev. 6 (1-09) - Laotian
  • DE 2511/S - Rev. 6 (1-09) - Spanish
  • DE 2511I/S - Rev. 5 (1-09) - Spanish - Printer-friendly version
    
  • DE 2511/T - Rev. 5 (1-08) - Thai
  • DE 2511/V - Rev. 7 (1-09) - Vietnamese
• The Medical Provider's Guide to Paid Family Leave
  • DE 2548F - Rev. 1 (2-09)
• Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts
  • DE 2588 - Rev. 5 (1-09)
• Disability Insurance (DI) and Paid Family Leave (PFL) Weekly Benefit Amounts in Dollar Increments
  • DE 2589 - Rev. 2 (1-09)
• Fact Sheet
  • Paid Family Leave - DE 8714CF - Rev. 9 (1-09) - English
  • Paid Family Leave - DE 8714CF/S/ - Rev. 9 (1-09) - Spanish