Paper claim checklist
A printable from SDI and PFL Without Papers. Fill it in by hand. Nothing you write is collected by this website.
Paper claim checklist
Get the form
- Ordered DE 2501 (Disability Insurance) or DE 2501F (Paid Family Leave) on ____________
- Asked my doctor (or my family member's doctor) to fill out the medical part
On the form
- Question A1 left blank (no Social Security number of my own)
- Number I used to earn wages listed, or left blank: ____________
- Other names I used for work listed
- Signed and dated
My letter
- My preferred language: ____________
- Other names I used: ____________
- Numbers I used to earn wages: ____________
- How I was paid (check, deposit, cash) and, for cash, how much and how often: ____________
- Why I am late, if I am late: ____________
Proof of wages (copies only)
- W-2s for this year and last year, or
- Pay stubs from the last 18 months
- Bank deposits or payment app records for cash pay
Before I mail it
- I made a copy of everything
- Disability Insurance: mailing within 49 days. Paid Family Leave: within 41 days
- I wrote down the date I mailed it: ____________
From SDI and PFL Without Papers. Facts checked October 21, 2026. Free information, not legal or medical advice.