California form physical disabilities 2025

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The DE 4365DI or DE 4366PFL will tell you what additional documents you must send to us to verify your identity. The form will also give you the date to respond, usually 10 calendar days from the mailing date. You should respond as soon as possible to avoid delays on your claim or a denial of benefits.
Request for Continued Benefits Physician/Practitioners Supplementary Certificate(DE 2525XX) Access this form by logging in to your myEDD account and selecting SDI Online. You can also complete this certification using the paper form that your patient will receive by mail with their final payment.
Ask the doctor to provide as much evidence as possible. X-rays, test results, medication history, or even dates of surgery can help prove that you have a long-standing condition. The doctor should also explain how your condition affects your ability to work. You can tell your doctor what type of evidence you need.
Your physician/practitioner can find and file this form online using SDI Online or you can provide them with a paper form. 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).
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.

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It cannot be downloaded or reproduced. To submit the DE 2501 electronically, visit How to File a Disability Insurance Claim in SDI Online. To submit by US mail, visit How to File a Disability Insurance Claim by Mail.

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