Form 2555 California San Bernardino 2024-2025

Form 2555 California San Bernardino: What You Should Know

The disability insurance program provides payments for qualified persons who have a physical or mental impairment which substantially limits one or more major life activities, or who are regarded as having such an impairment. This program applies only to persons who are covered by employment-related self-insured medical insurance when they are paid by the employer who provides the insurance. The program does not apply to paid-in-approximation health insurance. Download the Disability Insurance Provisions Brochure (DE 2515 — EDD) (PDF) (HTML) (PDF) (PDF). Contact Information Call toll-free or x912 or 1-866-632–2821. If you are a qualified recipient or your disabled spouse or child is a qualified recipient, contact your local Social Security Administration (SSA) office by filling out this form. Download the SSI Application for Certification of Employment (DE 2515 — EDD and DS 1040 — DS) and DS 1040 Certification of Receipt of Disability Benefits (PDFs) (PDF) Download the Supplemental Security Income Application for Certification of Employment (DE 2515 — EDD) (PDF).

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