Form DE 2501
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DE 2501 Form (Claim for Disability Insurance Benefits)

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What Is A DE 2501 Form?

In case, you are a disabled worker and due to this are suffering loss of your salary, then you have to fill out and submit form DE 2501. This is the Claim for Disability Insurance Benefits document. It serves as a request for special aid due to the injury or illness that prevents you from performing job. The application paper should be prepared for certain purposes. Firstly, to confirm your eligibility for the benefits. It is also important for different government institutions in order to collect information about individuals who can’t ensure the maintenance of children or spouse.

The document DE 2501 has to highlight the following information:

  1. Social security numbers of the claimer.
  2. The date when the person got disabled.
  3. The last day the individual worked.
  4. Whether the claimer was working any days being already disabled.
  5. The date he or she started to work after recovery (if this occurred).
  6. The applicant’s gender, full name and date of birth.
  7. Language.
  8. Email address and contact numbers.
  9. Reason the employee stopped working.
  10. Contact details of the employer.
  11. Occupied position.
  12. Whether it is permitted to disclose benefit details to employers.
  13. Date of DE 2501 creation and the claimer’s signature.

The completed form has to be forwarded to the Employment Development Department. It is recommended preparing the document electronically to save your time and nerves. You may choose an appropriate template, easily enter required details, put an electronic signature and send the file via email, fax or sms. If necessary, print a blank and fill it out by hand.

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