DI / DE 2514-71

SAMPLE, this page for reference only

EDD - PAID FAMILY LEAVE
PO BOX 997017
SACRAMENTO CA 95899-7017
Blank Box

Notice of Paid Family Leave (PFL) Benefits Determination – 90 Days From the Termination Date

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 and ending MM/DD/YY because:

The military assist benefit period you are requesting exceeds 90 days from the termination date of your military family member’s covered active duty.

Basis : California Unemployment Insurance Code (CUIC) Section 3302.2.

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 and send it to the EDD office shown above.

DE 2514-71 (12-20) (INTRANET)