Form DE 2501, Claim for Disability Insurance (DI) Benefits, is a form to request, by mail, worker-funded benefits to eligible workers who have a full or partial loss of wages due to disabilities that are not work-related.
Your employer will be notified if you submit a DI claim, but your personal information is confidential and will not be shared. The California Unemployment Insurance Code (CUIC) states that any illness or injury - either physical or mental - that prevents you from doing regular work is a disability. This also includes surgeries and complications related to pregnancy or childbirth.
The California Disability form was issued by the Employment Development Department on . A printable DE 2501 Claim Form is available for download below.
Pressing the PRINT button will only print the current page. Download the document to your desktop, tablet or smartphone to be able to print it out in full.