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Select the 
Submit 
Electronic 
Paid Family 
Leave Care 
Attachment 
link. 
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Verify the receipt 
number on the 
screen with the 
number you 
received when 
you filed the 
claim. If it 
matches your 
claim, choose the 
Select link from 
the Action
column to attach 
your form to your 
claim.
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Select the 
Browsebutton 
to upload the 
completed 
documents from 
your computer.
Note:To 
browse and 
attach a 
document, you 
will need to 
have previously 
scanned and 
saved the 
document on 
your computer 
as a PDF, JPG, 
JPEG, TIF, or 
TIFF file. 
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This screen  
shows one 
document already 
uploaded.
To upload another 
document, select 
Yesand then 
select Submit.
This will navigate 
you back to the 
Attachmentpage 
to continue 
uploading 
additional 
documents.     
When you are 
done uploading, 
select No and 
then select 
Submit.
84
VB.NET PDF: How to Create Watermark on PDF Document within
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This page confirms that the attachments have been submitted.
Save the Receipt Numberfor future reference. 
You have now completed your care claim which should be processed by the 
EDD within 14 business days.
Physician Certificate 
-
1234
85
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SDI Online Tutorial: 
Paper Forms
86
Claim for Disability Insurance 
(DI) Benefits, Form DE 2501
The DE 2501 for DI benefits and the DE 2501F for PFL benefits are scanned to 
interface with SDI Online. These forms may not be submitted as photocopied 
versions or faxed to the EDD for processing.
If you have already applied online, you do not need to file a paper claim form. 
Duplicate claim requests will delay claim processing.
87
Claim for Paid Family Leave 
(PFL) Benefits, Form DE 2501F
Claim for Disability Insurance (DI) 
Benefits, DE 2501, Part A -Claimant’s 
Statement, pages 1-4. 
Page 1 – The Health Insurance 
Portability and Accountability (HIPAA) 
Authorization needs to be signed by 
the claimant.
Pages 2, 3, and 4 – Complete the 
claimant information. Page 4 needs to 
be signed by the claimant.
88
DE 2501, Part B -
Physician’s/Practitioner’s Certificate,
pages 5-7.
All appropriate information including 
dates, diagnosis, and treatment codes 
must be completed by the 
physician/practitioner. The 
physician/practitioner needs to sign page 
7.
89
Claim for Paid Family Leave (PFL) 
Benefits, DE 2501F, Part A -
Statement of Claimant, page 1. 
Complete the information, 
including whether this is for a 
bonding or care claim. Make sure 
to sign and date the form.
90
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