Disability Insurance claim checklist
A printable from State Disability Insurance. Fill it in by hand. Nothing you write is collected by this website.
Disability Insurance claim checklist
Before you file
- The date I stopped working: ____________
- Day 9 (earliest day to file): ____________ Day 49 (last day): ____________
- My doctor or health professional knows I am filing and will complete the medical part
- My employer's name, address and phone, as on my pay stub or W-2
- The last day I worked my normal hours
- Pay stubs or W-2s, in case EDD asks about my wages
- How I want to be paid: direct deposit (online claims only), debit card or check
After you file
- I got my Notice of Computation (DE 429D) and checked my wages on it
- I send back every form EDD mails me (DE 2500A or DE 2593) on time
- If I go back to work early, I tell EDD
- If I am still not well near the end date, my doctor fills out DE 2525XX
From State Disability Insurance. Facts checked October 21, 2026. Free information, not legal or medical advice.