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continued claim certification for paid family leave benefits de 2580gf Preview on Page 1

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PFL provides paid time off, allowing eligible employees to receive a portion of their regular salary while on leave for qualifying family and medical purposes. However, FMLA provides unpaid leave for eligible employees.
If you have not fully recovered and need to continue your benefits, you must submit a Physician/Practitioners Supplementary Certificate (DE 2525XX) with your final payment. Have your physician/practitioner complete and submit this claim form to find out if you are eligible for an extension.
Certify to Continue Benefits If you reported that you worked or will work during your PFL period, you will receive the Continued Claim Certification for Paid Family Leave Benefits (DE 2580GF). You must complete this form to certify for the days you have worked during your PFL period.
If you reported intermittent leave or continued work on your claim form, you will receive the Continued Claim Certification for Paid Family Leave Benefits (DE 2580GF) to certify to the days you have worked during your claim. Your benefits will stop if you do not return the DE 2580GF to us online or by mail.
The PFL medical certification form requires you to certify that your patient has a serious health condition that requires care from a family member. The PFL recipient is not your patient, but your patients caregiver.
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To order the DE 2501F to submit by mail: Visit Online Forms and Publications. Select Keyword(s) or Form Number from the dropdown. Enter DE 2501F for an English form or DE 2501F/S for a Spanish form. Select Search. You can also call 1-877-238-4373 and select Option 3.

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