Welcome to the Employment Development Department

Manual Forms

Instructions on Printing and Completing the Disability Claim Form for SDI Benefits, DE 2501 - Manually

  1. Use the Internet Browser’s print function to print the blank form.
  2. You may use a typewriter to complete the form, or you may hand print your answers.
  3. Review your answers to be sure your answers are correct and complete.
  4. Place your signature in both “Claimant’s Signature” spaces in both Item 31 and Item 32 and print the date in the “Date signed” spaces in both items. If you prefer to complete a Health Insurance Portability and Accountability Act (HIPAA) Authorization in large print, you may also complete, sign, and date page 4.
  5. You may wish to make a photocopy of your claim for your records.
  6. Mail or bring your claim form (completed, signed “Claim Statement of Employee” plus the blank “Doctor’s Certificate”) to your doctor for completion of the “Doctor”s Certificate” portion. If your doctor will mail your completed form to Disability Insurance (DI), provide them with an envelope addressed to the DI Office nearest you.
  7. To avoid loss of benefits, your claim must be postmarked no earlier than 9 days but no later than 49 days after the first day you became disabled. Mail your completed, signed “Claim Statement of Employee” together with the completed, signed “Doctor's Certificate” to the DI Office closest to your residence.