Are You Applying for State Disability Insurance (SDI)? FILING YOUR SDI CLAIM There are two ways to file your State Disability Insurance claim Online or by mail using the new claim form. REGISTER AND FILE A CLAIM ONLINE- 3 STEP PROCESS вЂў Log on the EDDвЂ™s website at http://www.edd.ca.gov/Disability/ and select SDI Online. Choose SDI Online Registration and complete the questions вЂў Filing your claim online reduces processing time and provides immediate electronic confirmation of your claim 1. TO REGISTER, YOU WILL NEED THE FOLLOWING INFORMATION: вЂў Legal name вЂў Valid e-mail address вЂў Date of birth вЂў Social Security number вЂў California driverвЂ™s license or state ID вЂў U.S. or International physical address вЂў Mailing address вЂў Valid phone number 2. TO FILE A DI OR PFL CLAIM ONLINE YOU WILL NEED: вЂў Your username and password вЂў For State government employees, bargaining unit number вЂў Date your disability began вЂў Last day worked for this employer prior to date disability began вЂў Classification and description of your job functions вЂў Sick, vacation, paid time off, annual or вЂ�otherвЂ™ pay provided by your employer (if applicable) вЂў WorkersвЂ™ Compensation benefit information (if applicable) вЂў Last or current employer name and mailing address as found on W2 or paycheck stub вЂў Alcohol Recovery or Drug-Free facility information (if applicable) вЂў Document the receipt number that displays once your claim is submitted вЂў PFL claims require EDD Authorization 2501FC to be completed and sent to EDD within 10 days. Claim will not be approved without required EDD authorization. 3. ONCE YOUR CLAIM HAS BEEN SUBMITTED ONLINE, PLEASE PROVIDE THE RELEASE OF MEDICAL INFORMATION/MEDICAL SECRETARIES WITH THE FOLLOWING: вЂў Your Patient Receipt Number should be R10000000XXXXXXX вЂў Name, Date of Birth and Kaiser Permanente Medical Record Number вЂў Before calling Release of Medical Information/Medical Secretaries staff please confirm with your doctor that the Work Activity Status Form has been completed вЂў If filing for a PFL claim you must provider a copy of EDD authorization This information may be provided via any of the following methods: пѓј E-mail: DSAROMI@kp.org пѓј Phone: 925-817-5661 пѓј Fax: 877-883-5917 Are You Applying for State Disability Insurance (SDI)? COMPLETE AND MAIL A PAPER CLAIM TO EDD- 3 STEP PROCESS To file a claim by mail, you must use the new RED claim form for Disability Insurance (DI) Benefits, DE 2501 Rev. 78. EDD will not accept any other forms. вЂў Complete your paper claim form using the new RED DE 2501 Rev. 78 вЂў After mailing your claim form to EDD, please allow 7 business days for mail, delivery and processing before contacting Kaiser Permanente Release of Medical Information / Medical Secretaries to have Kaiser Permanente submit the medical portion of the claim 1. IF YOU COMPLETE YOUR CLAIM BY MAIL, PLEASE: вЂў INITIAL EDD COMPLETE ONLY CLAIMANTS PART A, PAGES 1THROUGH 4. вЂў PFL COMPLETE ONLY CLAIMANTS PAGES 1 THROUGH 3 вЂў Use only black ink to complete the paper form вЂў To ensure proper processing of your claim print legibly and inside the boxes provided. вЂў Forms can be obtained from: п‚§ Kaiser Permanente Release of Medical Information / Medical Secretaries Departments п‚§ Local State Disability/Employment Development Department Offices п‚§ Employers п‚§ Telephone: вЂў 1-800-480-3287 in English вЂў 1-866-658-2246 en EspaГ±ol 2. ONCE CLAIM IS COMPLETED MAIL DIRECTLY TO DISABILITY INSURANCE EDD Initial Claim Mail to: PFL Claim Mail to: State of California Paid Family Leave Employment Development Department Employment Development Department PO Box 989777 PO Box 997017 West Sacramento, Ca 95798-9777 Sacramento, Ca 95799-7017 3. ONCE YOUR CLAIM HAS BEEN MAILED AFTER SEVEN BUSINESS DAY, PLEASE PROVIDE THE RELEASE OF MEDICAL INFORMATION/MEDICAL SECRETARIES STAFF WITH THE FOLLOWING: вЂў Last four digits of your Social Security Number, Name, Date of Birth and Kaiser Medical Record Number вЂў Before calling Release of Medical Information/Medical Secretaries please confirm with your doctor that the Work Activity Status Form has been completed This information may be provided via any of the following methods: пѓј E-mail: DSAROMI@kp.org пѓј Phone: 925-817-5661 пѓј Fax: 877-883-5917 VOLUNTARY PLANS If you are insured by a Voluntary Plan maintained by your employer, you will need to contact your employer for information on the proper forms. NON-INDUSTRIAL DISABILITY INSURANCE (NDI) If you are a State government employee, please check with your personnel office for instructions on filing an NDI or DI claim, or call EDD at 1-866-352-7675.