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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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.

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. It cannot be downloaded or reproduced.

Paid Family Leave – Forms and Publications

If any questions arise related to the information contained in the translated website, please refer to the English version. All are available free of charge, whether you download or order for delivery by mail.


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.

To order an original form, visit Online Forms and Publicationsor call Deaf, speech impaired, and hard of hearing callers can contact PFL directly by Teletypewriter TTY this number does not accept voice calls. Some forms and publications are translated by the department in other languages. gorm

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. Forms and Publications Labor Market Information.

Inquiries about individual claims using this form will not be answered. To submit by US mail you must first order a claim form. These brochures may be downloaded and provided as official notices to employees.

If you have not received this form 250f1 10 days after your disability claim ends, please call For those forms, visit the Online Forms and Publications section. When calling via the California Relay Serviceplease provide the Paid Family Leave number to the operator.


The EDD is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information or changes in the formatting of the pages resulting from the translation application tool. 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.

Employers are not required to provide the PFL claim forms to their employees. You may need to download the free Adobe Reader to view and print linked documents.