Fill De f Form Download, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile with PDFfiller ✓ Instantly ✓ No software. Description of form de f. Claim for Paid Family Leave PFL Benefits F PART A STATEMENT OF CLAIMANT CARE OR BONDING PROVIDER A3. violation o! California law pLinishable lɔx imprisonnierit ar tirc; or both. Iste larg uncler FKnally cof EH’r Cury that the. Statenient, irmcluding any accompanying.

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New Paid Family Leave (PFL) Benefits Form Required July 1

To request general program information or data about State Disability Insurance, complete the State Disability Insurance Request for Information Form DE E and return it to the Employment Development Department using the appropriate email address listed on the form. Gorm calling via the California Relay Serviceplease provide the Paid Family Leave number to the operator.

To submit by US mail you must first order a claim form. For those forms, visit the Online Forms and Publications section. It cannot be downloaded or reproduced.


Forms and Publications Labor Market Information. All are available free of charge, whether you download or order for delivery by mail.

Deaf, speech impaired, and hard of hearing callers can contact PFL directly by Teletypewriter TTY this number does not accept voice calls. Employers are not required to provide the PFL claim forms to their employees. If you have not received this form within 10 days after your disability claim ends, please call These brochures may be downloaded and provided as official notices to employees.

Paid Family Leave – Forms and Publications

Any discrepancies or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes. The EDD is unable to guarantee the accuracy of this translation and is therefore not liable ofrm any inaccurate information or changes in the formatting of the pages resulting from the translation application tool.

If any questions arise related to the information contained in the translated website, please refer to the English version. Inquiries about individual claims using this form will not be answered.


Some forms and publications are translated by the department in other languages. If you are a woman currently receiving Disability Insurance pregnancy-related benefits, it is not necessary to request a Claim for Paid Family Leave Benefits.

PFL law requires employers to provide the Paid Family Leave – DE brochure only to new employees and employees who request leave to care for a seriously ill family member or bond with a new child. You may need to download the free Adobe Reader to view and print linked documents.

The web pages currently in English on the EDD website are the official and accurate source for the program information and services the EDD provides. To order an original form, visit Online Forms and Publicationsor call

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