DI / DE 2514-01

SAMPLE, this page for reference only

EDD - PAID FAMILY LEAVE
PO BOX 997017
SACRAMENTO CA 95899-7017
SAMPLE CLIENT
‎1234 ANY ST
ANY CITY CA 99999-9999
 

Notice of Denied Paid Family Leave (PFL) Benefits - Not Working or Looking For Work

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

We are unable to pay you Paid Family Leave (PFL) benefits for MM/DD/YY through when eligible because:

We are unable to verify that you were either working, looking for work, registered for work at a public employment office, or receiving state disability insurance (SDI) benefits in the three months prior to the time you began your PFL leave. Therefore, based on our records, you were not suffering a loss of wages because you were providing family care.
Basis:
California Code of Regulations (CCR), title  22, section 3302-1.

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 2514-01 Rev. 4 (12-20) (INTRANET)