DI / DE 2470B

SAMPLE, this page for reference only

Response to Request for Information

Maling Date:
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The Paid Family Leave (PFL) has received your request for payment information. We are unable to process your request because:

English:
1-800-300-5616
Chinese:
1-800-547-3506
Spanish:
1-800-326-8937
Vietnamese:
1-800-547-2058
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If you have any questions after reading this form call ‎1-800-480-3287 for DI claims, or ‎1-877-238-4373 for PFL claims. TTY (non-voice) access (for deaf and hearing-impaired persons only) is available at ‎1-800-563-2441 for DI and ‎1-800-445-1312 for PFL claims.

DE 2470B Rev.1 (9-21) (INTRANET)