CA DE 1378DI 2012 free printable template
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APPLICATION FOR DISABILITY INSURANCE ELECTIVE COVERAGE Complete this application only if you meet the requirements as set forth in the attached Information Concerning Elective Coverage. APPROVED:
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What is CA DE 1378DI?
CA DE 1378DI is a form used in California to report information regarding disability benefits and other income.
Who is required to file CA DE 1378DI?
Individuals who receive disability benefits from the California Employment Development Department (EDD) or those who have self-employment income are required to file CA DE 1378DI.
How to fill out CA DE 1378DI?
To fill out CA DE 1378DI, individuals should provide their personal information, details of their disability benefits, and report any additional income. The form must be completed clearly and accurately.
What is the purpose of CA DE 1378DI?
The purpose of CA DE 1378DI is to ensure that the state has accurate information regarding the benefits being received and to assess eligibility for disability-related payments.
What information must be reported on CA DE 1378DI?
Information that must be reported on CA DE 1378DI includes the recipient's name, Social Security number, the nature of the disability, details of the benefits received, and any other sources of income.
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