Welcome to the Employment Development Department

Request a Claim Form for State Disability Insurance Benefits

En Español
Name:
(Please enter your business name if you are an employer ordering more than 5 forms.)
Mailing Address:
City:
State: Zip Code:
E-Mail Address:
if no E-Mail Address, please enter “none@edd.ca.gov”
Telephone Number:
please format: (999) 123-4567
  ENTER QUANTITY REQUESTED
DE 2501 - Claim for State Disability Insurance Benefits:
DE 2501/S - Spanish instructions for completing the DE 2501 claim form:
  NOTE: These are instructions in Spanish only; to file a claim, you must complete the DE 2501 (English).

NOTE: Submitting this information will send an unencrypted e-mail message to the SDI Customer Service Unit. This information will be used only to mail you a Claim for State Disability Insurance (SDI) Benefits, DE 2501, form. Please allow 5-7 working days to receive your order. If you prefer not to request a claim form over the Internet, please call 1-800-480-3287 or 1-866-658-8846 (En Español).