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EDD DE 8501: NDI Physician Certificate (Part C)

California state employees who are not covered by State Disability Insurance claim Nonindustrial Disability Insurance (NDI) on this paper form when a non-work-related disability, including pregnancy, keeps them from working. The employer fills in Part A, the employee Part B, and the treating physician or practitioner certifies the disability in Part C, including diagnosis, ICD code and expected return-to-work date.

Who completes it

The treating licensed physician or practitioner completes and signs Part C; the attendance clerk or payroll officer completes Part A and the employee Part B. A patient seeing an accredited religious practitioner uses the DE 2502 instead.

Submitting and payment

How to submit it
NDI is paper only, so SDI Online cannot be used. Once Part C is complete, the form is mailed to EDD's NDI office, and employees should apply within 49 days of the date the disability began.
Who pays
If EDD requires a medical exam to confirm the disability, the State pays the exam fees; the form lists no fee for completing Part C.

Good to know

  • Item 13 needs a specific release or anticipated return-to-work date; 'indefinite' or 'unknown' is not accepted, and a blank date delays the claim.
  • The primary ICD code (item 5) and the date disability began (item 12) are required, and surgery entries call for ICD and CPT procedure codes.
  • Sign by hand: a rubber stamp is not acceptable, and the certification is made under penalty of perjury under Unemployment Insurance Code section 2708.
  • The current edition is Rev. 15 (10-25). Family care leave for the same employees uses the DE 8501F.

Get the official form

Download the current version from the source each time; forms change without notice.

First Claim for Nonindustrial Disability Insurance (NDI) (Part C - Physician/Practitioner Certificate)

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Can the DE 8501 be submitted through SDI Online?

No. EDD says NDI is not automated: claimants request and complete the paper DE 8501, usually from their personnel specialist or payroll officer, and the completed form, including the physician's Part C, is mailed to the NDI office.

Who is covered by California Nonindustrial Disability Insurance?

California state government employees not covered by SDI who have permanent or probationary status and are active PERS or STRS members. Permanent part-time and intermittent employees need six months of service in the prior 18 months, and CSU employees qualify at half-time or more for at least one year.