As you navigate your CA EDD claim filings, you may find that you have to submit your claim(s) via paper forms. This process can be a bit confusing, so we've collated some common questions and guidance below! This article is non-exhaustive, so we always recommend reviewing the CA EDD's website as well for the most up to date guidance.
For more information on filing intermittent claims with the EDD directly, see their Intermittent leave FAQ here.
What is an intermittent leave?
Intermittent leave is leave taken in separate blocks of time due to a single qualifying reason. If you are on an intermittent leave, you may return to work at irregular intervals (e.g. days, weeks, or months apart).
When you file a claim with intermittent leave legs, the CA EDD requires that you submit a detailed work letter specifying the leave legs where you will be away from work and the hours you will be working.
What is a detailed work letter?
When filing your disability or paid family leave claim, the EDD only allows you to enter your first day of leave and the last day of your leave, even if there are multiple legs. Since you may return to work at various points in this date range, both state and private disability providers require a detailed work letter that outlines which days you’ll be working throughout your leave, along with the number of hours worked. This letter is required so that state and private disability providers can distribute your benefit payments correctly.
How does taking intermittent leave affect my claims and pay?
In general, filing via paper forms will mean a significantly longer processing time than the typical two week turnaround seen with online claims. On average, paper claims see approval between 6-8 weeks post submission. However, we have facilitated some paper claims that have required upwards of three months for approval due to the CA EDD’s antiquated processes with paper mail.
If after 2-3 weeks you haven't heard anything back from the EDD, we recommend reaching out to them directly to check in on your claim status.
For guidance on contacting the EDD, please see our Contacting the CA EDD article!
Why might I need to file via paper forms?
If you are unable to provision a CA EDD account online, you will need to file by paper mail.
You may be unable to file online for the following reasons:
You don’t have a California Driver’s License or ID
Your California Driver’s License or ID is expired
EDD is unable to register your account based on the information you’ve provided or the information provided is inaccurate
You have filed for claims or unemployment with the EDD before under a different name/maiden name or your name is too long for their systems
Your medical provider will not certify claims online
Your medical provider is not in the state of California
How do I fill out my paper claim?
We’ve provided detailed instructions below to guide you through the process:
CA EDD Claim for Disability Benefits |
1. Provide HIPAA Authorization
The first section of your claim is HIPAA Authorization, which you must provide so that your medical provider can release information for your disability claim. This certification MUST be completed by a licensed medical provider.
2. Complete the Claimant's Statement section
A1: Your social security number
A2: Your historical account information (if applicable)
A3: Your CA driver’s license number (leave blank if you do not have one)
A4: Your gender for claim filing purposes
A5: Provide past information
A6: Select as applicable
A7: Your own date of birth
A8: Your First Name, Middle Initial, Last Name
A9: Other names as applicable
A10: Your own phone number
A11: Your own cell phone number
A12: Your preferred language
A13: The address you wish to receive payment
A14: Your mailing address.
Note that if it differs from your residential address, the EDD often flags this as fraud and may deny/freeze payments.
A15: Your Employer’s name - include your employer's name
Employer's address - include this address on your claim form
548 Market St #68975
San Francisco, California 94104
Please note that the employer mailing address linked to your claim is Cocoon’s office address. We use this address in order to help facilitate your claims and ensure any documentation that needs to be filled out by your employer is quickly and accurately returned to the EDD!
A16: Complete as applicable
A17: The last day you worked before going on disability leave for your first leg of leave
A18: The first day your disability began (or the first day you wish for your payments to start) for your first leg of leave.
Note that this day should match the first day certified by your medical provider
A19: Please provide a date if applicable
A20: Select “Yes” to to indicate intermittent leave
A21A: Leave blank as your medical provider will certify the day of your recovery
A21B: Enter the date you returned or will return to work after your last leg of leave.
Note: This should NOT be the last day of your leave, otherwise you will not be paid for that day. If you require more time beyond the time your medical provider has certified, this requires a new certification.
A22: Your personal social security number
A23: Your occupation (ie “Engineer” or “Salesperson”)
A24: Select “illness, injury or pregnancy”
A25: Select the description as applicable
A26: If your employer tops up your leave benefits, write “LSDI”. Otherwise, leave blank.
A27: Select “Yes” to ensure proper pay reconciliation with your employer
A28: Input as applicable
A29: Check as applicable
A30: Input as applicable
A31: Select as applicable. Please note that answering “Yes” may deny disability benefits
A32: Select “No”
A33: Input as applicable
A34: Input as applicable
A35: Your personal social security number
A36: Input as applicable
A40: Remember to sign and date!
3. Ask your medical provider to complete the Physician/Practitioner’s Certificate section
The physician/practitioner’s certificate must be certified by a medical provider on the original paper claim. The dates that your medical provider certifies are the dates that the CA EDD will pay out for your benefits – so make sure the dates certified by your provider match the dates of your leave plan.
If your medical provider wishes to certify online, you must first mail your “Claimant’s Statement” to the CA EDD at the address below to receive a Receipt Number. Then, give your Receipt Number to your medical provider so that they can certify your claim online. Often, certifying online will speed up the processing time.
Mailing Completed Disability Claims
Once you have completed your paper claim for disability, mail it to the following address along with the required detailed work letter (example below):
State of California Employment Development Department PO Box 989777 West Sacramento, CA 95798-9777 |
CA EDD Claim for Paid Family Leave (PFL) Benefits |
If you are a birthing parent, once your disability payments are fully paid, you will be able to submit your claim for PFL benefits. This follows the same process as non-birthing parents who apply for intermittent PFL benefits.
1. Complete the Statement of Claimant section
A1: Your personal social security number
A2: Your own date of birth
A3: Select “English”
A4: Your First Name, Middle Initial, Last Name
A5: Your gender for the purposes of filing the claim
A6: Your own phone number
A8: The mailing address you wish to receive payment
A9: Name of your employer and their mailing address
A10: The last day you worked before going on your first leg of leave
A11: The day you want to start getting paid
A12*: The day you plan to return to work after your last leg of leave.
A13: Select “Yes” to indicate intermittent leave
A14: Select “bond with child”
A15: Your occupation (ie “Engineer” or “Salesperson”)
A16: Cocoon recommends selecting “check” as EDD Debit cards may have withdrawal limits that may be subject to fraud freezes.
If you are interested in setting up direct deposit through the EDD Debit Card process through Bank of America, please select “EDD Debit Card”.
A17: The legal first and last name of your child
A18: Select “Child”
A19: Select “No” to avoid any chance of claim denial
A20: Select “Yes” or “No” if applicable
A21: Select what is applicable
A22: If your employer is topping up your leave, please input “LPFL”. If they are not paying you, input “N/A”
A23: Select “Yes”
A24: Select what is applicable
A25: Remember to sign and date!
2. Complete the Bonding Certification
B1: Your personal social security number
B2: Leave blank if the child is biological
B3: Select “Child”
B4: Your legal last name
B5: If you do not have your child’s social security number at the time of filing, you may leave this section blank.
B6: Input your child’s Date of Birth
B7: Select your Child’s Gender for claim filing purposes.
B8: Input the legal First Name, Middle Initial, and Last Name of your child
B9: Leave Blank. If you input a different address, the EDD will frequently flag address discrepancies between your address and your child’s residence address as potential fraud.
B10: At the time of claims filing, you may not have other documentation except a Hospital Verification Letter. If you do not have other forms of documentation like a birth certificate, select “Other” and write in Hospital verification Letter.
B11: Remember to sign and date! Please note that the claim date should be on or after the birth date of your child.
3. Include documentation about your child
Please remember to print and include a copy of your child’s birth verification or documentation to include with your paper claim mailing.
Sample verification letter:
4. Skip Section C
Skip Section C as this section is only applicable for caregiver leaves.
5. Skip the Medical Certification section
Skip Section D as this section is only applicable for caregiver leaves.
6. Mail in your completed PFL claim
Once your claim is completed (remember to include all original pages and documentation), send the claim to the following CA EDD address along with the required detailed work letter (example below):
Paid Family Leave - EDD PO Box 989315 West Sacramento, CA 95798-9315 |
CA EDD Detailed Work Letter Example |
To the California EDD,
I am writing to inform the state of my intermittent bonding leave dates:
Leg 1: I plan to start my first leg on [start date] and plan to return to work on [next weekday after end date]. My work schedule is as follows: Monday (xam-xpm), Tuesday (xam-xpm), Wednesday (xam-xpm), Thursday (xam-xpm), and Friday (xam-xpm) for a total xxhrs per week.
Leg 2: I plan to start my next leg on [start date] and plan to return to work on [next weekday after end date]. My work schedule is as follows: Monday (xam-xpm), Tuesday (xam-xpm), Wednesday (xam-xpm), Thursday (xam-xpm), and Friday (xam-xpm) for a total xxhrs per week.
Leg 3: I plan to start my next leg on [start date] and plan to return to work on [next weekday after end date]. My work schedule is as follows: Monday (xam-xpm), Tuesday (xam-xpm), Wednesday (xam-xpm), Thursday (xam-xpm), and Friday (xam-xpm) for a total xxhrs per week.
Please contact me at [your cell] for additional questions on my work schedule, or contact my employer [insert employer name].
Sincerely,
[Your Signature]
[Insert Your Name]
CA EDD Detailed Work Letter for Physician Example Note: This can be sent to your medical provider to ensure they certify your correct leave dates. |
x/xx/xxxx
To Dr. [Insert Your Physician’s Name],
I am writing to inform you of my intermittent medical leave dates as required by the CA EDD and [Insert Name of Private Disability Carrier].
The CA EDD and [Insert Name of Private Disability Carrier] requires that the leave dates are listed from the start of my first leg through the end of my last leg. I then supply a detailed work letter like you see below with my claim to provide the days worked in between each leg:
Leg 1: I started my leave on [start date] and plan to return to work on [next weekday after end date]. My work schedule is as follows: Monday (xam-xpm), Tuesday (xam-xpm), Wednesday (xam-xpm), Thursday (xam-xpm), and Friday (xam-xpm) for a total xxhrs per week.
Leg 2: I started my next leg on [start date] and plan to return to work on [next weekday after end date]. My work schedule is as follows: Monday (xam-xpm), Tuesday (xam-xpm), Wednesday (xam-xpm), Thursday (xam-xpm), and Friday (xam-xpm) for a total xxhrs per week.
Please contact me at [your cell] for additional questions on my work schedule, or contact my employer [insert employer name].
Sincerely,
[Your Signature]
[Insert Your Name]
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