Disability Insurance - Forms and Publications

Forms

(publications are listed separately below)

Claim for Disability Insurance (DI) Benefits – DE 2501 Rev. 78 (4-12)
To submit the DE 2501 electronically, complete a one-time registration to establish an online account. To register, go to the SDI Online page and select SDI Online Registration. Once the registration is complete, you may log in and complete your claim by visiting the SDI Online Login page. To order a claim form, use the Online Forms and Publications page or call 1-800-480-3287 or 1-866-658-8846 (en español).
Claim for Disability Insurance (DI) Benefits – Spanish – DE 2501/S – Rev. 78 (4-12)
To submit the DE 2501/S electronically, complete a one-time registration to establish an online account. To register, go to the SDI Online page and select SDI Online Registration. Once the registration is complete, you may log in and complete your claim by visiting the SDI Online Login page. To order a claim form, use the Online Forms and Publications page or call 1-800-480-3287 or 1-866-658-8846 (en español).
Physician/Practitioner’s Supplementary Certificate DE 2525XX Rev. 3 (3-12)
If you will be disabled beyond the original period established on your claim, have your Physician/Practitioner complete and submit the DE 2525XX online by accessing SDI Online. To order the form, call 1-800-480-3287 or 1-866-658-8846 (en español).
Annual Income Report for Disability Insurance Elective Coverage
- DE 945 - Rev. 6 (11-13)
Application for Disability Insurance Elective Coverage
- DE 1378DI - Rev. 43 (2-12)