DI / DE 2514-18

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 Paid Family Leave Benefits - Simultaneous Voluntary Plan (VP) Coverage

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

Your Paid Family Leave (PFL) benefit from the State has been reduced for the period beginning MM/DD/YY through MM/DD/YY because our records indicate that you have simultaneous coverage under your employer's voluntary plan(s) and the State PFL Program.

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