DI / DE 2514-17

SAMPLE, this page for reference only

EDD - PAID FAMILY LEAVE
PO BOX 997017
SACRAMENTO CA 95899-7017
SAMPLE CLIENT
‎1234 ANY STREET
ANY CITY
 

Notice of Reduced Weekly Paid Family Leave (PFL) Benefit Rate ‑ Simultaneous Voluntary Plan Coverage

 
Mailing Date:
MM/DD/YY
Claim Effective Date:
MM/DD/YY
Your Paid Family Leave (PFL) weekly benefit rate has been reduced because our records indicate you are entitled to receive benefits from one or more of your employer's voluntary plans for the same period.
Basis:
California Code of Regulations (CCR), title  22, section 3253-1.

This determination is final unless you send a written appeal within thirty days from the mailing date above. You may appeal by completing the enclosed Appeal Form or separately writing a detailed statement of why you believe the determination is in error. Please include your Social Security number on your appeal and send it to the EDD office shown above.

Notice of Determination

DE 2514-17 Rev. 2 (03-18) (INTRANET)