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July 16, 2018
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State Disability Forms
Updated On: Jun 29, 2012

The California State Disability Forms have been uploaded for your convenience. You may download the forms by either clicking on the links in the table below or by clicking on the link at the bottom of the page.

How to Apply

Disability Insurance (DI) provides services primarily by telephone, by mail, and in person. You do not need to apply in person to receive benefits. The online version of the DE 2501 may be filled-in and printed. To order claim forms, use the Request A Claim Form for State Disability Insurance Benefits or call 1-800-480-3287 or 1-866-658-8846 (En Español).

Instructions on How to Complete and File a Disability Insurance Claim:
General Instructions Additional Instructions
1. Carefully decide the date you want your claim to begin as this will determine your weekly benefit amount. Disability Insurance Claim Form
2. Complete ALL items on the “Claim Statement of Employee“ and sign it. Make certain that all information is complete and accurate since errors or omissions may cause your claim to be returned and may delay payment. Disability Insurance Claim Form

Instructions on Completing the Online Claim for SDI Benefits, DE 2501

Instructions on Printing and Completing the Disability Claim Form for SDI Benefits, DE 2501 – Manually
3. Doctor’s Certification: Ask your doctor to complete and sign the “Doctor’s Certificate” (page 3)

The following licensed health care providers are authorized to sign the Doctor’s Certificate portion of the DE 2501, for patients under their care and for conditions within their scope of practice:
  • Physician and Surgeon holding a M.D. or D.O. degree
  • Chiropractor
  • Dentist
  • Optometrist
  • Podiatrist
  • Psychologist
  • Nurse midwife or licensed midwife (For normal pregnancy and childbirth only)
  • Nurse Practitioner (For all conditions within scope of practice. In order to certify disabilities other than normal pregnancy and childbirth, the nurse practitioner must perform a physical examination and collaborate with a physician and/or surgeon.)
Other individuals who can certify to a disability include:
  • Accredited religious practitioner
  • Registrar of a county hospital in California
  • Medical officer of a United States government medical facility
  • State or local health officer
Note: If a nurse practitioner is certifying a Claim for Disability Benefits for a disability other than a normal pregnancy or childbirth, he/she must complete, print and sign the “Nurse Practitioner Certification for Disability Insurance Benefits, DE 2509A” and attach it to the Claim for Disability Benefits, DE 2501.
Disability Insurance Claim Form

Nurse Practitioner Certification For Disability Insurance Benefits, DE 2509A
4. Cannot Complete Form: If you cannot complete the claim form because of your disability, or if you are an authorized agent filing for benefits on behalf of a physically incapacitated, mentally incapacitated, or deceased claimant, you will need to request the appropriate form(s) for your situation. Call 1-800-480-3287 for further instructions.
5. Religious Practitioner: If you are under the care of an accredited religious practitioner, you must include with your claim form a “Practitioner's Certificate, “DE 2502. Ask your practitioner to complete and sign it. (Rubber stamped signature facsimiles are not accepted.) Call 1-800-480-3287 to get a Practitioner's Certificate, “DE 2502”
6. Temporary Workers’ Compensation: If you are receiving temporary Workers' Compensation benefits and are filing for reduced DI benefits for the same days, the Doctor's Certificate is not required. None
7. Mail your claim to the DI office nearest to your residence no earlier than 9 days--but no later than 49 days--after the first day you became disabled. Mail your completed, signed “Claim Statement of Employee” together with the completed, signed “Doctor's Certificate“ and any other supporting documents.

DI Office Locations

Closest Location to Bakersfield, CA:

Employment Development Department
P.O. Box 32
Fresno, CA 93707-0032

NOTE: The United States Postal Service (USPS) will not deliver mail to a private mail box (i.e., a mail box rented to you by a non-USPS commercial enterprise) unless it is preceded by the initials “PMB.”


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  Current Campaigns  
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