De8714cDE 8714C Rev.35 (12-11)
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CUP.O.Box PlanA Voluntary Plan is a private plan approved by the the Voluntary Plan matches the State Plans bene ts,
t, and costs the About 3.9 percent of Californias workers are covered by SDI Voluntary Plans.Voluntary Plans with mutual consent of the employer and a majority of the employees.
An employee may choose State Plan coverage even though a Voluntary
ts ts are payable when a covered employee suffers a wage loss and cannot work due to pregnancy
ts are To receive bene t payments, a person must: File a claim in accordance with regulations.
Serve a 7-day nonpayable waiting period.
Have been paid at least $300 in wages, subject to SDI
Submit to a reasonable medical examination, if
File a certi cate of disability signed by a duly authorized medical or religious practitioner.
led by mail and bene ts are generally paid
cations ts.No SDI payments can be made to
ts.A disabled person is also ineligible for disability
ts: When receiving Unemployment Insurance or PFL
When receiving full wages (bene t payments and wage, excluding overtime pay, immediately prior to
When in legal custody as a result of a conviction or
when con ned by a court order.
If religious exemption from SDI taxes has been
led.If the individual is no longer in the labor market.When receiving Workers Compensation at a
weekly rate equal to or greater than the SDI rate.impartial Administrative Law Judge (ALJ) concerning
t amounts.Further appeal from an ALJ's decision may be
led with the Unemployment Insurance Appeals Board, or the Board may set aside the ALJ's decision on its own motion.
should contact the Social Security Administration
ts under its programs.covered by PFL insurance.PFL bene ts are available to persons who take time off work and are suffering DE 8714CF, for further information.)www.edd.ca.govTTY access is available at 1-800-563-2441.DE 8714C Rev.35 (12-11)
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De2515(Fold)(Fold)(Fold)(Fold)How to Claim State Plan Bene ts1.Request a claim form: By telephone:
By Internet: www.edd.ca.gov By TTY (teletypewriter for deaf, hearing-impaired and speech-impaired persons only):
By mail: EDD, Disability Insurance,
In person by visiting any of the DI of ces listed under Disability Insurance Of ce Locations.California State government employees covered by SDI should telephone 2.Fill out and sign the Claimants Statement
Print clearly, and be sure that your ansare complete and correct because errors may delay payments.3.Have your doctor complete the Physician/Practitioners Certi cate.Usually a claim cannot begin more than seven days before you were ysician/practitioner.Certimay be made by a osteopathic physician and surgeon, nurse practitioner, chiropractor, dentist, podiatrist, optometrist, designated psychologist, or an Government facility.Certi cation may also be made by a licensed nurse-midwife or licensed midwife for disabilities related to normal pregnancy or childbirth.Mail your claim form within 49 days from
rst day you were disabled.If your claim is late, y ts unless of the delay is accepted as How Bene ts Are Paid The SDI Program is designed to serve you by mail or online.
You do not need to appear in person to apply for or receive beneEDD is an equal opportunity aids and services are available upon requestto individuals with disabilities.Requests for services, by calling DI at 1-800-480-3287 (voice), or TTY 1-800-563-2441, or PFL at 1-877-238-4373 or TTY This pamphlet is for general information only, and does not have the force and effect of the law, PROVISIONSDE 2515 Rev.
Page 1 of 2 CU cesAlameda .....1600 Harbor Bay Parkway, Ste.
120(write to: PO Box 1857, Oakland, CA 94604-1857)Chico .....................................645 Salem Street(write to: PO Box 8190, Chico, CA 95927-8190)Chino Hills ..15315 Fair eld Ranch Road, Ste.100(write to: PO Box 60006, City of Industry, CA 91716-0006)Fresno ...........2550 Mariposa Mall, Rm.1080A(write to: PO Box 32, Fresno, CA 93707-0032)Long Beach ...4300 Long Beach Blvd., Ste.
600(write to: PO Box 469, Long Beach, CA 90801-0469)Los Angeles ......888 S.Figueroa Street, Ste.200(write to: PO Box 513096, Los Angeles, CA 90051-1096N.
Los Angeles...15400 Sherman Way, Rm.500(write to: PO Box 10402, Van Nuys, CA 91410-0402)San Bernardino ...................371 West 3rd Street(write to: PO Box 781, San Bernardino, CA 92402-0781)9246 Lightwave Avenue, Bldg.A, Ste.300(write to: PO Box 120831, San Diego, CA 92112-0831)San Francisco .......745 Franklin Street, Rm.300San Jose .....................297 West Hedding Street(write to: PO Box 637, San Jose, CA 95106-0637)Santa Ana ..605 West Santa Ana Blvd., Bldg.
28, Rm.735(write to: PO Box 1466, Santa Ana, CA 92702-1466)Santa Barbara .................128 East Ortega Street(write to: PO Box 1529, Santa Barbara, CA 93102-1529)Santa Rosa ...................606 Healdsburg Avenue(write to: PO Box 700, Santa Rosa, CA 95402-0700)Stockton ...................528 North Madison Street(write to: PO Box 201006, Stockton, CA 95201-9006).