Fillable Printable De8717D
Fillable Printable De8717D
De8717D
SDI ONLINE
SDI Online makes it faster and easier
to process Disability Insurance and
Paid Family Leave claims!
www.edd.ca.gov/disability
EASY
No paper, envelopes, or postage.
Check Disability Insurance claim
status and payment history online.
Create an account in less than
10 minutes!
SECURE
Security safeguards against the
illegal use of your information.
Health Insurance Portability and
Accountability Act (HIPAA) compliant.
CONVENIENT
Shorter claim processing time.
Immediate confirmation of claim filed.
Available 24 hours a day!
DE 8717D Rev. 1 (1-14) (INTERNET)
SDI ONLINE
www.edd.ca.gov/disability
GETTING STARTED
To create an SDI Online account, you
will need:
• Legal name.
• Valid e-mail address.
• Date of birth.
• Social Security number.
• California Driver License or
California Identification Card number.
• Physical and mailing address.
• Valid phone number.
USING SDI ONLINE
To file a Disability Insurance or Paid
Family Leave claim through SDI Online,
you will need:
• Your most current employer’s
business name, telephone number,
and mailing address as stated on your
W2 form and/or paycheck stub.
• The last date you worked your regular
or customary duties and hours.
• The date you began working less than
full duty or modified duty.
• Wages you received or expect to
receive from your employer, sick
leave, paid time off (PTO), vacation
pay, annual leave, and wages earned
after you stopped working.
• Workers’ Compensation claim
information, if applicable.
• The name, address, and telephone
number, if any, of the alcoholic
recovery home or drug-treatment
facility where you are currently
receiving in-patient treatment.
• Paid Family Leave bonding
information, if applicable.
