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California Disability Insurance CoverageForm Change Request F66Name (print) Instructions Complete this form indicating to which plan you want to change and return it to Payroll Operations in one of
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What is California Disability Insurance Coverage Form?

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Instructions for the form California Disability Insurance Coverage

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California disability insurance coverage provides partial wage replacement to workers who are unable to work due to a non-work-related illness, injury, or pregnancy.
Employers in California are required to provide disability insurance coverage for their employees.
Employers can fill out the California disability insurance coverage forms online through the Employment Development Department website.
The purpose of California disability insurance coverage is to provide income protection for workers who are unable to work due to a disability.
Employers must report information such as employee wages, hours worked, and disability claim details on the California disability insurance coverage forms.
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