Get Edd Disability Extension Form Pdf

To search and order brochures and forms from the EDD, visit Online Forms and Publications....Forms Visit Online Forms and Publications. Select Keyword(s) or Form Number from the dropdown. Enter DE 2501 for an English form or DE 2501/S for a Spanish form. Select Search.

English: 1-800-480-3287. Spanish: 1-866-658-8846.

You may submit medical certifications using SDI Online or by completing and mailing the paper claim form: Claim for Disability Insurance (DI) Benefits (DE 2501) or Claim for Paid Family Leave (PFL) Benefits (DE 2501F). For more information, visit Certify and Manage Claims – Basics for Physicians/Practitioners.

How to Certify. For Disability Insurance claims, fill out and sign Part B – Physician/Practitioner's Certificate on the Claim for Disability Insurance (DI) Benefits (DE 2501) form. Mail it in within 49 days from the date your patient's disability begins.

Complete the entire form by answering all questions using black or blue ink. Provide your gross wages, total number of hours worked, and complete employer information for each week that you worked. Be sure to sign your name next to the “X” on the signature line and return the form by the due date indicated.

The DE 2500A, commonly called a continued claim certification, is your request for continued disability benefits. By signing and dating the front of the form, you certify that during the dates shown on the continued claim certification you were still disabled.

If your claim is on automatic payment, after 10 weeks of payment, you will receive a Disability Claim Continued Eligibility Questionnaire (DE 2593). Return the form to the EDD either by mail or through your SDI Online account to certify that your disability continues.

If You Need to Extend Your DI Period You will receive a Physician/Practitioner's Supplementary Certificate (DE 2525XX) with your final payment. Have your physician/practitioner complete and submit this form to find out if you are eligible for an extension. Your physician/practitioner can find your claim in SDI Online.