DI / DE 2514-23

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 - Benefits Exhausted

MAILING DATE:
MM/DD/YY
CLAIM EFFECTIVE DATE:
MM/DD/YY

No further Paid Family Leave (PFL) benefits are payable from MM/DD/YY through when eligible because you have exhausted the maximum benefit amount for this PFL 12-month period. You may be eligible for a new PFL 12-month period one year after the Claim Effective Date shown above.

Basis : California Unemployment Insurance Code (CUIC), Section 3301 (c) (d)

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 2514-23 Rev. 2 (03-18) (INTRANET)