DI / DE 2587

SAMPLE, this page for reference only

Serving the People of California

State of California / Health and Welfare Agency/ Employment Development Department

NOTICE OF AUTOMATIC PAYMENT

YOUR PAYMENTS

Your claim for disability benefits is in an automatic payment cycle. Benefit payments will be issued approximately every 14 days. (If you do not receive a payment within 21 days of your last payment delivery, please contact this office). You will not need to return certification forms for payment as you may have done on past claims. When it is necessary for you to complete a certification form, one will be provided.

YOUR RESPONSIBILITY

To prevent an overpayment on your claim, you must immediately notify the Department if you recover from your disability or return to work. Failure to notify the Disability Insurance field office of a change in your claim status can be construed as fraud against the Disability Insurance program and can result in penalties including fine, imprisonment, and loss of benefit rights, as provided in the California Unemployment Insurance Code (CUIC).
If you expect your disability to be long-term, you should contact the social security information line at ‎1-800-772-1213 to find out about additional benefits that might be available.

HOW TO NOTIFY THE DEPARTMENT

When you recover from your disability or return to work, immediately complete this form and mail it to the Disability Insurance field office.

RECOVERY OR RETURN TO WORK CERTIFICATION

I certify that I recovered from my disability or returned to work on Blank line
Sign Your Name Blank line
Date Signed Blank line
RETURN THIS FORM TO
Blank Space

DE 2587 Rev. 6 (8-21) (INTRANET)