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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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.

Employers are not required to provide the PFL claim forms to their employees. All are available free of charge, whether torm download or order for delivery by mail. You may need to download the free Adobe Reader to view and print linked documents.


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.

New Paid Family Leave (PFL) Benefits Form Required July 1 –

If you have not received this form within 10 days after your disability claim ends, please call 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. 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.

Any discrepancies or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes.

If any questions arise related to the information contained in the translated website, please refer to the English version. 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.


Some forms and flrm are translated by the department in other languages.

For those forms, visit the Online Forms and Publications section. It cannot be downloaded or reproduced.

Paid Family Leave – Forms and Publications

To submit by US mail you must first order a claim form. 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.

When calling via the California Relay Serviceplease provide the Paid Family Leave number to the operator. Inquiries about individual claims using this form will not be answered. These brochures may be downloaded and provided as official notices to employees. Forms and Publications Labor Market Information.