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DE 2501F, Care Recipient 
Authorization for Disclosure of 
Personal-Health Information, page 2.
The person receiving care, or his/her 
authorized agent, must sign the 
bottom of this page.
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DE 2501F, Part B - Bonding  
Certification(bonding claims only) 
and Part C -Statement of Care 
Recipient (care claims only), page 3. 
Part B – For bonding claims the 
claimant must complete all bonding 
information and sign the form.
Part C – For care claims the care 
recipient or claimant must fill out the 
appropriate care information. The 
care recipient or their authorized 
representative must sign the form.
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DE 2501F, Part D -Doctor’s 
Certification, page 4.
The physician/practitioner must 
complete all patient information for 
care claims, including dates and 
diagnosis codes. The 
physician/practitioner must sign the 
bottom of the form.
Claimants should make sure all 
pages are completed and all 
signatures are obtained before the 
claim form is mailed back to the 
EDD for processing.
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SDI Online Tutorial:
Username Recovery
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To recover your SDI Online username, visit www.edd.ca.gov/disability.
On the State Disability Insurance overview page select any SDI Online link. 
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On the State Disability Insurance (SDI) Online page, select the Log In to SDI Online link.
You will be directed to the SDI Online Login page.
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On the SDI Online 
Loginpage, select 
Forgot username?
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Provide your last name, email address, and select your user account type from the 
drop down menu. Your account type is either a claimant, a physician/practitioner, or 
an employer. Then select Next.
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Answer the 
security 
questions and 
select Next.
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Once you have 
successfully 
answered your 
security 
questions, your 
SDI Online 
username will be 
sent to your 
email address. 
Select Login to 
access your 
account with the 
username that 
was sent to your 
email. 
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