Disability Insurance Elective Coverage Forms and Publications 2025

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We offer an optional Disability Insurance Elective Coverage (DIEC) program for people who dont pay into State Disability Insurance (SDI) but want to be covered by Disability Insurance (DI) and Paid Family Leave (PFL).
If you lost or did not receive the DE 2525XX, you can request the form using your SDI Online account or by calling 1-800-480-3287 or 1-866-658-8846 (en espaol). Annual Income Report for Disability Insurance Elective Coverage (DE 945).
104 DE 2566F Request for Additional Information PFL requires claimant to provide identification information and/or proof of wages to determine eligibility The SSN is used to locate records and identify claimants.
Ordering a form online to have it mailed to you. Getting the form from your licensed health professional or employer. Visiting an SDI Office. Calling 1-800-480-3287 and selecting DI Information option 3 to request a paper form by mail.
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