DI / DE 2514-58

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 Denied Paid Family Leave (PFL) Benefits - Bonding Claim Filed Late With No Remaining Payable Days

Mailing Date:
MM/DD/YY
Claim Effective Date:
MM/DD/YY

We are unable to pay you PFL benefits from MM/DD/YY through when eligible because:

Your claim was filed later than 41 consecutive days following the first compensable day of your bonding claim and 41 consecutive days later than any other on which your claim states you were bonding with your child. Because your claim was filed this late, there is no remaining time for which you can be paid for this claim.

Basis : California Unemployment Insurance Code (CUIC), section 3301 (e).

PFL benefits are payable for any day of bonding within 365 days from the date of birth, adoption, or foster care placement of the child. Claims must be filed timely. Timely means a claim must be filed within 41 days of the first compensable day of the claim. None of the days for which you are claiming benefits falls within a timely claim receipt period.

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.

DE 2514-58 Rev. 3 (03-18) (INTRANET)