DI / DE 8517

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EDD Employment Development Department State of California Logo

Mailing Date:
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Claim Effective Date:
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Notice of Non-Industrial Disability Insurance (NDI) Determination

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We are unable to authorize your benefits from
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through
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because:
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The determination is based on:
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Employment Development Department Non-Industrial Disability Insurance PO Box 2168 Stockton, CA 95201-2168
Telephone ‎ 1-866-758-9768

The determination is final unless you send a written appeal within 30 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 below.

DE 8517 Rev. 4 (12-20) (INTRANET)