DI / DE 2597D

SAMPLE, this page for reference only

DISABILITY INSURANCE
PO BOX 201006
STOCKTON CA 95201-9006
SAMPLE CLIENT
‎1234 ANY ST
ANY CITY CA 99999-9999
 

Paid Family Leave (PFL) / State Disability Insurance (SDI) Claims Overlap

SSA Number:
‎XXX-XX-0000
MAILING DATE:
MM/DD/YY
The Paid Family Leave (PFL) office has notified us that you were paid PFL benefits for a period for which you are claiming State Disability Insurance (SDI) benefits. You cannot be eligible for both programs for same days.

To avoid a delay in issuing a check to you, this first State Disability Insurance (SDI) payment covers only a period following your PFL payments. Please contact the PFL office (1-877-238-4373) as soon as possible so that this matter may be cleared up quickly.

DE 2597D (6-04) (INTRANET)