Supplemental certification form edd

The tips below will help you complete Supplemental Certification Sdi quickly and easily: Open the template in our feature-rich online editor by clicking on Get form. Fill in the required fields which are colored in yellow. Click the green arrow with the inscription Next to jump from one field to another. Go to the e-signature tool to e-sign the ...

The amount remaining will be deducted from your weekly benefit amount. Example 1: Your weekly benefit amount is $50. You earn $30. You must report the $30; however, the first $25 is not counted, leaving $5 to deduct from your weekly benefit amount. You would receive $45 ($50 minus $5) in unemployment benefits.PO Box 826880, MIC 92G Sacramento, CA 94280‐0001 Fax Number: 1‐916‐464‐2711 Email: [email protected]. Please include the name, address, and phone number of the institution requesting the demand, the employer payroll tax account number, lien certificate number, and whether the demand should be mailed and/or faxed.The amount remaining will be deducted from your weekly benefit amount. Example 1: Your weekly benefit amount is $50. You earn $30. You must report the $30; however, the first $25 is not counted, leaving $5 to deduct from your weekly benefit amount. You would receive $45 ($50 minus $5) in unemployment benefits.Licensed Health Professional Forms and Publications - EDD Forms. Claim for Disability Insurance (DI) Benefits (DE 2501) (sample claim form). Fill out and submit Part B - Physician/Practitioner's Certificate. ... If You Need to Extend Your DI Period You will receive a Physician/Practitioner's Supplementary Certificate (DE 2525XX) with your ...Although the form is currently to complete, you will receive an email in logs in go SDI Online. Select Continued Eligibility Questionnaire in owner inbox. You must complete and submitted the DE 2593. If you received the DE 2593 per mail, you must return it to us within 20 days of the post date. If you submit this form late, you may lose benefits.

If you cannot complete this form due to your disability, or if you are an authorized representative filing for benefits on behalf of an incapacitated or deceased claimant, call 1-800-480-3287 or visit the EDD website to send an online message using Ask EDD at . https://askedd.edd.ca.gov. HOW TO COMPLETE THIS FORM • Use black ink only ...View Physician/Practitioner Supplementary Certification for Continuing Eligibility (DE 2525XX) Section 1 - AI Homework Help. Expert Help. Study Resources. ... Section 2 - Patient Information Section 3 - Form Information Receipt Number: R100000051152289 Issue Date: 03-23-2017 Due Date: 04-12-2017 Section 4 ...Certified Payroll Reporting. Contractors and subcontractors on most public works projects are required to submit certified payroll records (CPRs) to the Labor Commissioner using DIR's electronic certified payroll reporting system. A few categories of public works projects are exempt from reporting online to DIR. SDI includes: Disability Insurance. Paid Family Leave. Nonindustrial Disability Insurance (includes Disability Insurance and Family Care Leave) Claimants and employers must understand their roles and responsibilities to make sure that information is reported accurately and the correct benefits are paid. Committing fraud has serious outcomes. 1. Open the DE2525XX PDF file in a PDF viewer or editor. 2. Fill out the form fields by entering the requested information. 3. Review your information for accuracy, and then click the "Sign" button. 4. Enter your name and the date in the signature section, then click "Sign". 5.This Initial Soil RAP Application LSRP Supplemental Certification form shall be completed for a previously submitted Soil RAP Application that is pending Department review or for a new Initial Soil RAP Application for sites at which the retained LSRP can certify that all statements in the Certification Criteria section immediately below are ...Once your claim has been submitted online with the EDD, complete the SDI medical certification request so we can ensure your doctor has the documentation needed to …If you cannot complete this form due to your disability, or if you are an authorized representative filing for benefits on behalf of an incapacitated or deceased claimant, call 1-800-480-3287 or visit the EDD website to send an online message using Ask EDD at . https://askedd.edd.ca.gov. HOW TO COMPLETE THIS FORM • Use black ink only ...

How to edit Form 2500a edd: customize forms online. Find the correct Form 2500a edd template and edit it on the spot. Simplify your paperwork with a smart document editing solution for online forms. Your day-to-day workflow with documents and forms can be more effective when you have everything that you need in one place. Write what needs to be corrected on your Notice of Award and mail it to the EDD address on the notice. In your UI Online account, select Contact Us to request a change. Call the Unemployment Customer Service line at 1-800-300-5616, from 8 a.m. to 5 p.m. (Pacific time), Monday through Friday, except on state holidays.Eligibility Requirements. To be eligible for PFL benefit payments, you must have: Welcomed a new child into the family in the past 12 months through birth. Paid into State Disability Insurance (noted as "CASDI" on most paystubs) in the past 5 to 18 months. Not taken the maximum eight weeks of PFL in the past 12 months.The way to complete the Download form Edd form de 2525xx supplemental certification form on the web: To begin the blank, utilize the Fill camp; Sign Online button or tick the preview image of the document. Date medical condition or need for treatment commenced [NOTE: THE HEALTH CARE PROVIDER IS NOT TO DISCLOSE THE UNDERLYING DIAGNOSIS WITHOUT ...

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The tips below will help you complete Supplemental Certification Sdi quickly and easily: Open the template in our feature-rich online editor by clicking on Get form. Fill in the required fields which are colored in yellow. Click the green arrow with the inscription Next to jump from one field to another. Go to the e-signature tool to e-sign the ...Cognitive behavioral therapy (CBT) is a form of therapy that helps rewire thinking patterns. This may be key for treating ADHD. Cognitive behavioral therapy (CBT) is an increasingl...Statutory employees hired as author of a commissioned or specific ordered work agreed in signed contract to be a "work made for hire," as defined in Section 101 of Title 17, USC. Refer to. Information Sheet: Statutory Employees (DE 231SE). Subject Sections 621(d) and 686 of the CUIC. Subject Sections 621(d) and 686 of the CUIC.Handy tips for filling out De 2525xx form to print online. Printing and scanning is no longer the best way to manage documents. Go digital and save time with airSlate SignNow, the best solution for electronic signatures.Use its powerful functionality with a simple-to-use intuitive interface to fill out De 2525xx download online, e-sign them, and quickly share …

The 2525xx supplemental certification must include the following information: 1. The name and location of the person or entity seeking the certification; 2. The identity of the product or service being sought; 3. A description of the specific work or services to be performed; 4. The amount remaining will be deducted from your weekly benefit amount. Example 1: Your weekly benefit amount is $50. You earn $30. You must report the $30; however, the first $25 is not counted, leaving $5 to deduct from your weekly benefit amount. You would receive $45 ($50 minus $5) in unemployment benefits.correspondence you have received from the EDD, please call: DI at 1-800-480-3287 or PFL at 1-877-238-4373. Information regarding DI and PFL may also be accessed via the Internet at . edd.ca.gov/disability. The EDD is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.Paid Family Leave. Employees may be eligible for Paid Family Leave (PFL) benefits if they lose wages when they need to take time off work for family leave. Be aware of the basic eligibility requirements for your employees. Disability Insurance benefits can be paid only after your employees confirmed eligible by the EDD.Supplemental C Affidavit of Certification for the City of Oakland. Download Supplemental C Affidavit of Certification. The official website of the City of Oakland. Find out about meetings, request City services through OAK …Disability insurance provides partial wage replacement benefits to eligible California workers who are unable to work due to a non-work-related illness, injury, or pregnancy. The EDD manages the State Disability Insurance (SDI) program for the State of California and Disability Insurance (DI) is a component of the SDI program.The. Employee’s Withholding Allowance Certificate. (DE 4) is for. California Personal Income Tax (PIT. withholding. purposes only. The DE 4 is used to compute the amount of taxes to be withheld from your wages, by your employer, to accurately reflect your state tax withholding obligation. Beginning January 1, 2020,With the cooperation between airSlate SignNow and Chrome, easily find its extension in the Web Store and use it to electronically sign physician practitioner's supplementary certificate right in your browser. The instructions listed below will allow you to generate an eSignature for signing edd form de 2525xfa form edd form in Chrome:By mail. You can get a paper form at an SDI office, your employer, your doctor/medical practitioner's office, or by ordering a form online from EDD's Online Forms and Publications (the form will be mailed to you). EDD explains how to file an SDI claim by mail. To apply for Paid Family Leave to care for a relative with a disability, the forms ...To add a medical representative to your Physician/Practitioner account on SDI Online, you will need: Representative's legal name. Valid e-mail address. Date of birth. Last four digits of their Social Security number. Treatment address where the medical representative is located. DE 8516 Rev. 2 (8-13) (INTERNET)Jan 1, 2024 · These are licensed health professionals responsible for the supplemental examinations that verify a disability status by providing a second medical opinion when the original certification is in question. Examinations by the SDI program follow the guidelines listed in Section 2627 (c)-1 (b) of Title 22 of the California Code of Regulations. How to fill out de 2525xx supplemental certification. 01. Obtain a copy of the DE 2525XX form from the EDD website or your local EDD office. 02. Fill out the personal information section, including your name, address, social security number, and date of birth. 03.

You can certify with UI Online or by mail using the paper Continued Claim Form (DE 4581) (PDF). When certifying for UI benefits, report your work and gross wages (wages earned before any deductions) during the actual week you worked and earned the wages, not when you received your pay. Note: The certification week always starts on a Sunday and ...

The tips below will help you complete Supplemental Certification Sdi quickly and easily: Open the template in our feature-rich online editor by clicking on Get form. Fill in the required fields which are colored in yellow. Click the green arrow with the inscription Next to jump from one field to another. Go to the e-signature tool to e-sign the ...You can also certify by phone using EDD Tele-Cert by calling 866-333-4606 and selecting Menu Option 2 to get started. First time users will need to enter their SSN, weekly benefit amount, and establish a four-digit PIN to use the system. If using the paper claim form, you should mail the form to the address provided and allow 10 days for ...Some Restrictions May Apply. EDD Tele-Cert has some system limitations. If you need to report work and wages, change of address, or phone number, you will need to certify for benefits with UI Online or mail the paper Continued Claim form (DE 4581) (PDF).; If you are participating in Work Sharing or have a Partial Claim, you can only certify by mail using the forms provided by your employer. The 2525xx supplemental certification must include the following information: 1. The name and location of the person or entity seeking the certification; 2. The identity of the product or service being sought; 3. A description of the specific work or services to be performed; 4. You must do this every 14 days from the date displayed on your claim form. We recommend that you certify for benefits with UI Online because it is a fast, convenient, and a secure way to certify. You can also certify by phone using EDD Tele-Cert SM at 1-866-333-4606. Report Accurately4. Certification: The person filing the claim must sign and certify that the information provided is true and correct to the best of their knowledge. Note: The specific information required may vary depending on the individual circumstances and …Submit fingerprints via Live Scan. The Request for Live Scan Service form (BCIA 8016FP) must be submitted to the agency providing the Live Scan service. The processing fee for a Fingerprint Rolling Certification is $74.00 ($32.00 for the California background check, $17.00 for the Federal background check, and a certification fee of $25.00).01. Edit your de 2525xx online. Type text, add images, blackout confidential details, add comments, highlights and more. 02. Sign it in a few clicks. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. 03. Share your form with others. Send de2525xx via email, link, or fax.Employment Development Department Procedures for Investigating Trade Disputes, DE 4654 ... This application includes the supplemental form for Disaster Unemployment Assistance (DUA) if you are unemployed or partially unemployed due to a disaster. ... The UI Branch will be referencing this form in other forms once the retroactive certification ...Employers must provide a copy of the following to each employee when appropriate. The following pamphlets explain employees' benefit rights: For Your Benefit: California's Programs for the Unemployed (DE 2320) (PDF): Provides information on UI, DI, PFL, and Job Service benefits available to the employee.; Disability Insurance Provisions (DE 2515) (PDF): This brochure outlines the DI program.

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Choose the form you will need in our library of legal templates. Open the document in our online editor. Look through the instructions to find out which data you have to provide. Select the fillable fields and put the required information. Put the date and insert your electronic autograph once you fill out all of the fields.Jan 1, 2024 · Authorized medical officer of a U.S. government facility. Chiropractor. Podiatrist. Optometrist. Dentist. Psychologist. Nurse practitioner or physician assistant after examination and collaboration with physician or surgeon. Licensed midwife, nurse-midwife, or nurse-practitioner for pregnancy, childbirth, or postpartum conditions consistent ... Call Us. Call 1-866-333-4606 and select Menu Option 1 to get information on your most recent payment.Payment information is updated daily at 6 a.m. (Pacific time). If you submit your certification by phone, your payment will generally be deposited on to your EDD Debit Card SM within 24 hours.Form to claim benefits on behalf of a deceased or incapacitated claimant. Physician/Practitioner's Supplementary Certificate (DE 2525XX) If your disability will extend beyond the original period established on your claim, have your physician/practitioner complete and submit the DE 2525XX online using SDI Online.Gavin Newsom, Governor California Labor and Workforce Development Agency PO Box 826880 • Sacramento, CA 94280-0001 • edd.ca.gov Dear California Employer: The Employment Development Department (EDD) understands your time is valuable.Forms and Publications. The PDFs on this website are replicas of the official EDD forms and publications. To complete forms, you may need to download and save them on the computer, then open them with the no-cost Adobe Reader. Visit Online Forms and Publications to search, view, and order State Disability Insurance forms.You are a proxy for, or caregiver of, a Kaiser Permanente member and need to request records on his or her behalf. Office. Phone. Email Address. Antelope Valley. 661-726-2129. [email protected]. Baldwin Park. 626-939-7120.How to fill out de 2525xx supplemental certification: 01. Obtain the de 2525xx form from your employer or download it from the appropriate government website. 02. Fill out the personal information section, including your name, address, and contact information. 03.Automated DI payment information is available 24 hours a day, 7 days a week, including holidays. Contact DI. Please contact us if you have any questions regarding any DI notices or forms. Telephone at: English: 1-800-480-3287 Spanish: 1-866-658-8846 SDI for State Employees: 1-866-352-7675.It's getting hot in here! Are there supplements for that? Why yes, there are. Advertisement There's no denying it: Temperatures are rising across the globe. And that means we need ... Both you and the patient must certify that the information provided on a DI or PFL claim is complete and accurate. Properly completed claims are generally processed within two weeks of our receipt. When reviewing your certification forms, we pay special attention to: If the estimated recovery date is longer than what normally would be expected ... Follow these quick steps to edit the PDF De 2525xx online free of charge: Sign up and log in to your account. Sign in to the editor using your credentials or click on Create free account to test the tool's capabilities. Add the De 2525xx for editing. Click on the New Document option above, then drag and drop the document to the upload area ... ….

The penalty for failing to timely file Form 2525xx Supplemental Certification is a civil penalty of up to $10,000 per violation. In addition, the Department of Labor may pursue other legal remedies available to it, including an injunction to stop the employer from doing business. Open the form in the online editing tool. Read through the guidelines to determine which data you need to include. Select the fillable fields and add the required information. Put the relevant date and insert your electronic signature as soon as you complete all of the fields. Examine the form for misprints as well as other mistakes. If your claim is go automatic payment, afterwards 10 weeks of payment, you will receive adenine Disability Claim Continued Eligibility Questionnaire (DE 2593). Return the application to the EDD either by mail or through your SDI Online account to certify that your disability continues. If you do not send the FROM 2593 within 20 days after receiving the create, your benefits will stop.Statutory employees hired as author of a commissioned or specific ordered work agreed in signed contract to be a "work made for hire," as defined in Section 101 of Title 17, USC. Refer to. Information Sheet: Statutory Employees (DE 231SE). Subject Sections 621(d) and 686 of the CUIC. Subject Sections 621(d) and 686 of the CUIC. EDD Asked Me to Call About a Claim Form. If you received a message to call EDD about your Claim Form, DE 4581, your reissued claim form was incomplete. Certify for benefits online 24 hours a day seven days a week through UI Online, fast convenient and secure. UI Online: Manage your claim 24 hours a day, seven days a week through UI Online. 01. Edit your physician supplementary certificate online. Type text, add images, blackout confidential details, add comments, highlights and more. 02. Sign it in a few clicks. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. 03. Share your form with others. PFL Claimant’s Certification section of the DE 2525XFA and have the care recipient’s Licensed Health Professional complete the Physician’s Supplementary Certificate section of the DE 2525XFA. Once completed, return this form to EDD. • If you misplaced the DE 2525XFA, request the form using AskEDD or by calling 1-877-238-4373.Disability insurance provides partial wage replacement benefits to eligible California workers who are unable to work due to a non-work-related illness, injury, or pregnancy. The EDD manages the State Disability Insurance (SDI) program for the State of California and Disability Insurance (DI) is a component of the SDI program."Physician/Practitioner's Supplementary Certificate (DE 2525XX): If your disability will extend beyond the original period established on your claim, have your physician/practitioner complete and submit the DE 2525XX online using SDI Online." Supplemental certification form edd, Select Allow and finish completing your unemployment application. If you are unable to verify your identity through ID.me when applying online, you will need to file a claim by phone, fax, or mail. For help with the ID.me verification process, you can: Speak to an ID.me video agent 24 hours a day, 7 days a week, through your ID.me account., 1. Open the DE2525XX PDF file in a PDF viewer or editor. 2. Fill out the form fields by entering the requested information. 3. Review your information for accuracy, and then click the "Sign" button. 4. Enter your name and the date in the signature section, then click "Sign". 5., Employers must provide a copy of the following to each employee when appropriate. The following pamphlets explain employees' benefit rights: For Your Benefit: California's Programs for the Unemployed (DE 2320) (PDF): Provides information on UI, DI, PFL, and Job Service benefits available to the employee.; Disability Insurance Provisions (DE 2515) (PDF): This brochure outlines the DI program., Forms and Publications. The PDFs on this website are replicas of the official EDD forms and publications. To complete forms, you may need to download and save them on the computer, then open them with the no-cost Adobe Reader. Visit Online Forms and Publications to search, view, and order State Disability Insurance forms., Feb 15, 2024 · California Unemployment Rate in March 2024. 0.0 K. New and Reopened Claims Filed for Week Ending April 20. $ 0 M. Benefits Paid for Week Ending April 20. 0.0 K. Backlog of Claims Past 21 Days Pending EDD Action for April 20. Services for Veterans. , Glucosamine is found naturally in humans. It is sold in many forms as a supplement. The sulfate form has the most evidence for treating osteoarthritis. Natural Medicines Comprehens..., Return completed certifications to the employee to provide to his or her employer. There are five DOL optional-use FMLA certification forms. Certification of Healthcare Provider for a Serious Health Condition. Employee's serious health condition, form WH-380-E (Spanish) - Use when a leave request is due to the medical condition of the employee., Doctor extended my DI by 2 weeks and submitted the " Physician/Practitioner’s Supplementary Certificate (DE 2525XX)" Form online. 2 days later, I received this message from SDI: Please have the physician/practitioner that is currently treating you complete the Request for Medical Information that will be mailed to you on the next business day., For all applicants, for weeks of unemployment between Dec. 27, 2020 and Sept. 4, 2021, EDD will add $300 of federal Pandemic Additional Compensation (PAC) to benefit weeks, on top of the other benefits you certify for. This money should come through automatically; applicants shouldn't need to make any adjustments on their claims to get it., Request since Continued Benefits - Physician/Practitioner's Supplementary Certificate (DE 2525XX) Access this form by logging in for your myEDD create and dial SDI Web-based. You can also complete this certification using the paper form which your case desire receive by mail with their final payment., Request since Continued Benefits - Physician/Practitioner's Supplementary Certificate (DE 2525XX) Access this form by logging in for your myEDD create and dial SDI Web-based. You can also complete this certification using the paper form which your case desire receive by mail with their final payment., Provides informational resources about programs and services available to people with disabilities. Oversees California Family Rights Act (CFRA). Provides information from the Children and Family Services Division of the Department of Social Services. The online resource for Workers' Compensation information provided by the Department of ..., If you are approved for California Training Benefits (CTB), a training extension (TE) can provide additional weeks of benefits while you complete your school or training.Only one TE is allowed for each CTB-approved training period. Note: You must contact us before you sixteenth week of benefit payments to qualify for a TE. Eligibility. To be eligible for a TE, you must:, You are a proxy for, or caregiver of, a Kaiser Permanente member and need to request records on his or her behalf. Office. Phone. Email Address. Antelope Valley. 661-726-2129. [email protected]. Baldwin Park. 626-939-7120., Gavin Newsom, Governor California Labor and Workforce Development Agency PO Box 826880 • Sacramento, CA 94280-0001 • edd.ca.gov Dear California Employer: The Employment Development Department (EDD) understands your time is valuable., You must do this every 14 days from the date displayed on your claim form. We recommend that you certify for benefits with UI Online because it is a fast, convenient, and a secure way to certify. You can also certify by phone using EDD Tele-Cert SM at 1-866-333-4606. Report Accurately, This video goes over the updated list of acceptable documents for proof of self employment/Planned employment/PUA verification. Remember, all critical information is in the r/EDD sidebar. Do not respond to any PMs or chats from anyone asking for your EDD info! Anyone asking for personal information is trying to scam you out of your money!, Claimants must complete the form within 49 days of becoming disabled and provide medical certification of the disability. Step-by-step DE 2501 Form instructions are provided below. Submit your claim no earlier than 9 days and no later than 49 days after your disability begins, or you may lose eligibility. Gather the required information., Aug 23, 2019 · Continued Claim Forms. You are required to submit a Continued Claim Form to the EDD every two weeks beginning with specific date of your claim filing. If you do not succeed in submitting the form, you will not get benefits for the period of that particular two-week period unless you provide good cause (a compelling reason) which prohibited you ... , We will also send you a Paid Family Leave (PFL) Supplemental Claim Certification (DE 2525XFA) with the Notice of Final Payment (DE 2525XF)., The buyer should ask you for a Certificate of Release of Buyer (DE 2220). See our Requirements for Obtaining Certificate of Release of Buyer When a Business Is Sold (DE 3409A) (PDF), and complete a Release of Buyer Request Form (DE 2220R) (PDF) to receive the DE 2220. Until the DE 2220 is issued, the buyer must hold enough funds in escrow to ..., Employers are required to withhold mandatory employee payroll deductions and send those contributions to the EDD for DI and PFL coverage. Please use the current State Disability Insurance Withholding Rate on the Tax Rate and Withholding Schedules. If you have questions about the contribution rate, contact your local Employment Tax Office., de 2525xx supplemental certification form pdf how do i get de 2525xx form edd disability extension form pdf how do i submit my edd medical provider form how do i ... Claim Filed (DE 2503F) Sent to you after the employee has filed a PFL claim. You must complete and return the paper form to the EDD within two working days to verify the ..., The California Disability form was issued by the Employment Development Department on April 1, 2019. A printable DE 2501 Claim Form is available for download below. supplementary certificate de 2525xx, Payments stopped because the initial physician assessment anticipated a return to work date of 1/1/22, but a second physician form extended the return to work date to 7/1/22. The claim now reflects the new return to work date, but no payment has been issued since 1/1. It says “To continue to receive payments, submit the Continued Claim ..., Read this article to find out how to get a lush, green lawn by applying iron. Iron is a popular lawn supplement, but it needs to be used correctly to prevent damage. Expert Advice ..., It is recommended you enroll in the Online Career Workshops Program to help maintain your work search requirements . This video goes over the updated list of acceptable documents for proof of self employment/Planned employment/PUA verification. Remember, all critical information is in the r/EDD sidebar. Do not respond to any PMs or chats from ..., Department Chair and Associate Professor of Counseling, Special Education, and Diversity, Education. Contact number: 281- 283-3534. Email: [email protected]. Office: Bayou Suite 1321. Randy L. Seevers Faculty Bio. The Special Education Supplemental Certification from UHCL will give you the foundation to augment your skills and increase your ..., For Paid Family Leave insurance, fill out and sign Part D - Physician/Practitioner's Authentication on the Claim on Paid Home Leave (PFL) Benefits (DE 2501F) form. Mail it in within 41 days from that choose family leave begins. Below you will find news on how to submit a certification. For more information, are offer a step-by-step learning., Handy tips for filling out Edd disability extension form pdf online. Printing and scanning is no longer the best way to manage documents. Go digital and save time with signNow, the best solution for electronic signatures.Use its powerful functionality with a simple-to-use intuitive interface to fill out Edd extension form california online, e-sign them, and quickly share them without jumping tabs., Guidance on the use of Supplemental Wage Information to implement the Performance Accountability Requirements under the Workforce Innovation and Opportunity Act (June 1, 2017) • DOL-only Performance Accountability, Information, and Reporting System - Office of Management and Budget (OMB) Control No. 1205-0521, Participat Individual Recordn, To submit by US mail, you must first order the form by calling 1-800-480-3287 or 1-866-658-8846 (en español)....Forms Visit Online Forms and Publications. Select Keyword (s) or Form Number from the dropdown. Enter DE 2501 for an English form or DE 2501/S for a Spanish form. Select Search., To add a medical representative to your Physician/Practitioner account on SDI Online, you will need: Representative’s legal name. Valid e-mail address. Date of birth. Last four digits of their Social Security number. Treatment address where the medical representative is located. DE 8516 Rev. 2 (8-13) (INTERNET)