DE 2501F is the Application for Paid Family Leave Benefits issued by the California Employment Development Department (EDD) for claiming Paid Family Leave (PFL) benefits. It serves people who take time off work to bond with a new child, care for a seriously ill family member or take part in a qualifying event linked to a family member's military deployment. On FillingPDF you can fill out the form online and download or print the completed PDF; EDD says to file on an original paper application or through SDI Online, as explained below, and publishes the sample form on its website.
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What is DE 2501F?
DE 2501F, Application for Paid Family Leave Benefits, is the California Employment Development Department (EDD) claim form for Paid Family Leave (PFL) benefits, used to bond with a new child, care for a seriously ill family member or take part in a military-related qualifying event.
California's PFL program provides up to eight weeks of benefit payments. The form has five parts, and which ones you complete depends on the type of claim:
- Part A – Claimant's Statement: required for every claim; you must complete and sign it.
- Part B – Bonding Certification: for a bonding claim.
- Part C – Statement of Family Member Receiving Care: for a care claim.
- Part D – Physician/Practitioner's Certification: for a care claim, completed by a licensed health professional.
- Part E – Military Assist Certification: only for a claim based on a family member's military deployment.
EDD names neighboring documents. DE 2501 is the Application for Disability Insurance Benefits. DE 2501FP, the bonding application for new mothers, is sent automatically to mothers receiving pregnancy-related disability benefits when that claim ends. DE 8501F is the claim for state employees in certain bargaining units. DE 2502F, the Practitioner's Certification for Paid Family Leave (PFL) Benefits, replaces Part D when the family member is under the care of an accredited religious practitioner. EDD also publishes the Guide for Completing a Claim Form for Paid Family Leave (PFL) Benefits (DE 2475).
Who needs to file DE 2501F?
People who take time off work to bond with a child, care for a family member or take part in a military-related qualifying event use DE 2501F to claim PFL benefits. EDD says to apply even if you are not sure you are eligible; it will tell you if you are ineligible for all or part of the claim.
To be eligible, you must:
- be unable to do your regular or customary work because of the leave reason;
- be employed or actively looking for work when leave begins;
- have lost wages, if you are working, because of the leave;
- have earned enough wages subject to State Disability Insurance (SDI) deductions during the past 5 to 18 months.
Bonding: the child must be your own or your registered domestic partner's biological, adopted or foster child. Care: the family member must be your child, spouse, registered domestic partner, parent, parent-in-law, grandparent, grandchild or sibling, under the treatment or supervision of a licensed health professional.
Do not complete this application if you are insured by a Voluntary Plan (ask your employer how to apply) or are a state government employee in bargaining unit 2, 5, 6, 7, 8, 9, 10, 12, 13, 16, 18 or 19; those employees use DE 8501F. You may not be eligible if you are claiming unemployment or disability benefits, receive Workers' Compensation at or above the PFL rate, or are in jail or prison.
Authorized representatives of an incapacitated or deceased person should call 1-877-238-4373.
When to file DE 2501F
You can apply the first day you take time off for leave, and you must apply within 41 days of that date to avoid losing benefits. If your application is late, include a written explanation of why. Late, erroneous or incomplete applications can delay your claim or lead to denied benefits.
Your claim can begin the first day you take time off, and you do not have to use all eight weeks at once. You cannot change the start date or adjust your base period after a valid claim is established. For a bonding claim, you must use PFL within 12 months of the birth, adoption or foster care placement.
After EDD receives a completed application, you receive information by mail in about two weeks, though processing time varies. Most claims are processed and payments issued within 14 days of receiving a correctly completed application.
Documents you need
- Bonding claim, question B10: a copy of one document proving your relationship to the child: child's birth certificate, declaration of paternity (CS-909), adoptive placement agreement (AD-907), independent adoption placement agreement (AD-924) or Other. Do not send originals; they are not returned.
- If you select Other at B10: a document with your name, your child's name and proof that you are providing care and financial support.
- Care claim: Part D, completed and signed by the family member's licensed health professional, submitted with Part A and Part C.
- Care claim, if the family member is under an accredited religious practitioner: Form DE 2502F, completed and signed by the practitioner, instead of Part D.
- Military assist claim, question E10: one document showing covered active duty orders, a letter of impending call or order to covered duty, or military leave documentation signed by the approving authority.
- Military assist claim, question E12: available written documentation supporting the need for leave, such as a meeting announcement, a rest and recuperation leave confirmation, an appointment or a bill for legal or financial services.
- Military assist claim, meeting with a third party: supporting documentation of the meeting with the name, address and contact information (phone, fax or email) of the person or entity.
- Part C, question C7: a copy of the power of attorney or court order when an authorized representative signs for the family member (for a spouse or domestic partner, contact EDD).
- A written explanation of the delay if your application is late.
- If you sign Part A with a mark (X): the names, signatures and addresses of two witnesses attesting it.
How to fill out DE 2501F
Enter your identity details
In Part A, answer A1 (Social Security number), A2 (date of birth), A3 (preferred language) and A4 (legal name). Add your gender identity at A5 and any other last names at A7. Use black ink and write clearly within the boxes.
Give your contact information
Enter your phone number at A6 and your mailing address at A8. For a private mailbox, begin the address with "PMB" and include the number in the PMB# space.
Describe your employer and leave dates
At A9 enter your employer's name, address and phone number. Then enter your last day worked (A10), the date you want your PFL claim to start (A11) and your return-to-work date (A12), and answer A13 on working during leave.
Explain the leave and choose payment
At A14 mark the reason you reduced or stopped work: care for family member, bond with child, military assist or other. Enter your usual occupation at A15 and choose Debit Card or Check at A16.
Identify the family member
At A17 enter the legal name of the person you are caring for or bonding with, or your military family member. At A18 mark their relationship to you.
Answer the eligibility questions
Complete A19 to A24, covering other available caregivers, workers' compensation, more than one employer, employer-paid leave, disclosure to your employer and law enforcement custody. Answer each one.
Sign and date Part A
Read the declaration at A25, sign without printing, and enter the date signed. If you sign with a mark (X), two witnesses must sign and give their addresses.
Complete Part B for bonding
Enter your Social Security number, the placement date for foster care or adoption and the child's relationship to you (B3). Add the child's details (B4 to B9), check one proof document at B10 and attach a copy, then sign and date at B11.
Complete Part C for family care
Enter the family member's birth date, phone, gender identity, name and address (C1 to C5). The family member signs C6, or an authorized representative completes and signs C7.
Have Part D completed
For a care claim, the licensed health professional completes D1 to D21 in upper case with black ink and signs. If an accredited religious practitioner is involved, they complete DE 2502F instead.
Complete Part E for military assist
Only for a military-related claim: enter the military member's details (E3 to E9), select the supporting document at E10, mark the qualifying event at E11, answer E12 and sign at E13.
Review and download the PDF
Check that every part for your claim type is complete, signed and dated and that your Social Security number is on every page. Download or print the completed PDF from FillingPDF and assemble the package described under How to submit.
How to submit DE 2501F
You can file a PFL claim through SDI Online (recommended by EDD) or by mailing the paper DE 2501F.
- SDI Online: access it through myEDD at edd.ca.gov/SDI_Online. EDD says online filing is faster, and direct deposit requires applying through SDI Online.
- By mail: mail the application using the envelope provided with the paper form. The form prints no other mailing address.
EDD states that you must use an original paper application form and cannot print or download a copy of the English-language claim form. Get a paper form by ordering it online, from your physician/practitioner or employer, at an SDI Office, or by calling 1-877-238-4373 and saying "Claim form"; allow up to ten days for delivery.
Your application is complete only if EDD receives:
- Bonding claim: Part A, Part B and supporting documentation.
- Care claim: Part A, Part C and Part D.
- Military assist claim: Part A, Part E and supporting documentation.
Rubber-stamped signatures are not accepted. If a disability prevents you from completing the application, or you are an authorized representative, call 1-877-238-4373 or use Ask EDD at askedd.edd.ca.gov. FillingPDF lets you fill out and download the PDF; submission follows the EDD channels above.
Common mistakes to avoid
- Applying more than 41 days after the first day of leave without a written explanation; the form warns you may lose benefits.
- Leaving the Social Security number off pages or attachments; the form asks for the number used to obtain benefits on all pages, including attachments.
- Using a rubber-stamped signature, which EDD does not accept; Part B and Part D also require an original signature.
- Sending the original proof of relationship at B10 instead of a copy; originals are not returned.
- Mailing an incomplete package, such as a care claim with Part A but without Part C and Part D.
- Completing Part D on a bonding or qualifying-event claim; the form says not to.
- Using DE 2501F when you are insured by a Voluntary Plan or are a state employee in a listed bargaining unit.
- Entering a private mailbox address at A8 without "PMB" at the start of the address or the number in the PMB# space.
- Signing Part A with a mark (X) without two witnesses and their addresses.
- Not reporting income such as sick pay, vacation pay or part-time wages, which can cause an overpayment, penalties or a false statement disqualification.
Frequently asked questions
What is DE 2501F?
DE 2501F is the Application for Paid Family Leave Benefits from the California Employment Development Department (EDD). You use it to claim PFL benefits to bond with a new child, care for a seriously ill family member or take part in a qualifying event linked to a family member's military deployment.
How long do I have to apply for Paid Family Leave in California?
You must apply within 41 days of the first day you take time off, or you may lose benefits. You can apply on that first day. If your application is late, include a written explanation of why.
Can I print or download DE 2501F to file it?
EDD says you must use an original paper application and cannot print or download a copy of the English-language claim form; the posted PDF is a sample. Order a paper form from EDD or file through SDI Online instead.
Where do I mail the DE 2501F application?
Mail it using the envelope that comes with the paper form; the form prints no separate address. To order the form, call 1-877-238-4373 and say "Claim form". You can also apply faster through SDI Online at edd.ca.gov/SDI_Online.
Which parts of DE 2501F do I complete?
Everyone completes and signs Part A. A bonding claim also needs Part B and supporting documentation, a care claim needs Part C and Part D, and a military assist claim needs Part E and supporting documentation.
How long does EDD take to process a Paid Family Leave claim?
EDD says you receive information by mail in about two weeks after it receives a completed application, and most claims are processed and paid within 14 days of a correctly completed application. Times can vary; SDI Online is faster.
Who cannot use DE 2501F?
People insured by a Voluntary Plan should ask their employer how to apply. State government employees in bargaining units 2, 5, 6, 7, 8, 9, 10, 12, 13, 16, 18 or 19 use the Claim for Nonindustrial Disability Insurance – Family Care Leave (NDI-FCL) (DE 8501F) instead.
Can someone claim PFL for a person who is too ill or has died?
Yes, in limited cases. If you are an authorized representative applying for an incapacitated or deceased person, call 1-877-238-4373 or message EDD through Ask EDD at askedd.edd.ca.gov. EDD also lists DE 1850J and DE 2522/DE 2522J for next of kin or legal representatives.
Can I fill out DE 2501F online on FillingPDF?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent, is not connected to EDD and does not file the claim; EDD requires an original paper form or SDI Online for filing.
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