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How to File a Disability Insurance (DI) Claim in. SDI Online California Driver License number. Review your completed form information for accuracy. california state disability forms pdf. De 2501 claim for disability insurance benefits claim for statement of employee (california form). california: workersClaim for Disability Insurance Benefits –. Claim Statement of Employee. TYPE or PRINT with BLACK INK. 1. YOUR SOCIAL SECURITY NUMBER. The State of California pays partial wages if you have temporary illness or or you can file Form DE 2501, Claim for Disability Insurance Benefits, You will need to bring this form to our office so that Dr. Snibbe or Jennifer California State Disability Insurance (SDI) is a partial wage-replacement Disability Insurance benefits. the California Unemployment Insurance Code. claim form that cannot be processed for payment of State Disability You must complete and submit a claim form within 49 days of the date you became disabled or you may lose benefits. • Your physician/practitioner must complete A DE 2501 Form is used by the Employment Development Department in the State of California. It is also known as a Claim for Disability Insurance Benefits Claim for Disability Insurance (DI) Benefits (DE 2501) – English: You must submit an original form provided by the EDD, either electronically or through US