YOUR CLAIM STATEMENT (PAGES 1 AND 2) AND THE DOCTOR'S CERTIFICATE (PAGE 3) MUST BE MAILED TOGETHER IN THE SAME ENVELOPE TO ONE OF THE DISABILITY INSURANCE OFFICES BELOW!

To ensure that you understand your rights and responsibilities, please read the Claim Filing & Processing section of this site before completing the Claim for State Disability Insurance (SDI) Benefits, DE 2501. For assistance in filling out the application, refer to How to Complete the Claim.

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You will need Adobe Acrobat Reader Version 4.0 or higher to successfully complete and print the DE 2501. If Version 4.0 or higher is not installed on your computer, you may download it at no cost from www.adobe.com/products/acrobat/readstep2.html

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After you have completed and signed the "Claim Statement of Employee," take it to your doctor along with the "Doctor's Certificate."

When your doctor has completed and signed the "Doctor's Certificate" portion of the claim form, review the list of SDI offices below, select the office which is closest to your residence, and mail the completed, signed "Claim Statement of Employee" together with the completed, signed "Doctor's Certificate" to that office.

State Disability Insurance P.O. Box 60006 City of Industry, CA 91716-0006	State Disability Insurance P.O. Box 32 Fresno, CA 93707-0032
State Disability Insurance P.O. Box 469 Long Beach, CA 90801-0469	State Disability Insurance P.O. Box 513096 Los Angeles, CA 90051-1096
State Disability Insurance P.O. Box 781 San Bernardino, CA 92402-0781	State Disability Insurance P.O. Box 120831 San Diego, CA 92112-0831
State Disability Insurance P.O. Box 1466 Santa Ana, CA 92702-1466	State Disability Insurance P.O. Box 1529 Santa Barbara, CA 93102-1529
State Disability Insurance P.O. Box 201006 Stockton, CA 95201-9006	State Disability Insurance P.O. Box 10402 Van Nuys, CA 91410-0402