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DI / DE 2552
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SAMPLE
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Notice of Registration - Religious Practitioner
Date Issued:
Blank space
Reference Number:
Blank space
Blank Box
Thank you for registering with the Employment Development Department (EDD) as an accredited practitioner of faith. You are now authorized to certify to a disability for Disability Insurance benefits, or the need for care for Paid Family Leave (PFL) benefits, as provided under California Unemployment Insurance Code (CUIC), section
2709
.
Disability Insurance (DI) Certification
When certifying to a disability, write your reference number shown above and sign the
Claim for Disability Insurance Benefits - Religious Practitioner's Certificate (
DE 2502
).
Paid Family Leave (PFL) Certification
When certifying to a need for care, write your reference number and sign the
Religious Practitioner's Certification for Paid Family Leave (PFL) Benefits
(
DE 2502F
).
Include your reference number in place of a license number on any other forms you complete for Disability Insurance (DI) or Paid Family Leave (PFL).
If you
did not
register as an accredited practitioner of faith, immediately report this by visiting
edd.ca.gov/en/about_edd/fraud
and selecting the
Report Fraud
link. The online fraud form is the fastest method to report fraud and you will receive a reference number for your submission. If you do not have access to the internet, you may call to speak with an
EDD
representative at
1-800-229-6297
.
Sincerely,
NAME, Manager
Disability Insurance (DI) Central Office Division
Enclosures:
Claim for Disability Insurance Benefits
(
DE 2501
),
Claim for Paid Family Leave (PFL) Benefits
(
DE 2501F
),
Claim for Disability Insurance (DI) Benefits - Religious Practitioner's Certificate
(
DE 2502
), and
Religious Practitioner's Certification for Paid Family Leave (PFL) Benefits
(
DE 2502F
)
PO Box 826880 • Sacramento, CA 94280-0001 • 1-916-654-8261
DE 2552 Rev. 16 (4-22)
Email Address:
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