Fill De f Form Download, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile with PDFfiller ✓ Instantly ✓ No software. Description of form de f. Claim for Paid Family Leave PFL Benefits F PART A STATEMENT OF CLAIMANT CARE OR BONDING PROVIDER A3. violation o! California law pLinishable lɔx imprisonnierit ar tirc; or both. Iste larg uncler FKnally cof EH’r Cury that the. Statenient, irmcluding any accompanying.

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Deaf, speech impaired, and hard of hearing callers can contact PFL directly by Teletypewriter TTY this number does not accept voice calls.

Forms and Publications Labor Market Information. For those forms, visit the Online Forms and Publications section. Employers are not required to provide the PFL claim forms to their employees.

The EDD is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information or changes in the formatting of the pages resulting from the translation application tool.


Inquiries about individual claims using this form will not be answered. To order an original form, visit Online Forms vorm Publicationsor call You may need to download the free Adobe Reader 25501f view and print linked documents. All are available free of charge, whether you download or order for delivery by mail.

Paid Family Leave – Forms and Publications

If you have not received this form within 10 days after your disability claim ends, please call The web pages currently in English on the EDD website are the official and accurate source for the program information and services the EDD provides. To request general program information or data about State Disability Insurance, complete the State Disability Insurance Request for Information Form DE E and return it to the Employment Development Department using the appropriate email address listed on the form.

These brochures may be downloaded and provided as official notices to employees. When 2501g via the California Relay Serviceplease provide the Dr Family Leave number to the operator. Any gorm or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes.


If any questions arise related to the information contained in the translated website, please refer to the English version. Some forms and publications are translated by the department in other languages.

Paid Family Leave – Forms and Publications

To submit by US mail you must first order a claim form. It cannot be downloaded or reproduced.

If you are a woman currently receiving Disability Insurance pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits. PFL law requires employers to provide the Paid Family Leave – DE brochure only to new employees and employees who request leave to care for a seriously ill ce member or bond with a new child.