DI / DE 2514-19

SAMPLE, this page for reference only.

EDD - PAID FAMILY LEAVE
PO BOX ####
ANY CITY CA 99999-9999
SAMPLE CLIENT
‎1234 ANY ST
ANY CITY CA 99999-9999
 

Notice of Reduced Paid Family Leave (PFL) Benefits - Court-Ordered Child Support Obligation

MAILING DATE:
MM/DD/YY
CLAIM EFFECTIVE DATE:
MM/DD/YY
We have reduced your Paid Family Leave (PFL) benefits beginning MM/DD/YY because:

Records indicate that you have an unpaid, court-ordered, child support obligation. An amount up to 25% of the benefits due you after all other reductions have been made shall be withheld and forwarded to the California Department of Child Support Services (DCSS) until we are notified that your obligation has been satisfied.

Basis : California Unemployment Insurance Code (CUIC), section 2630

Any question you have concerning your support obligation should be directed to the Department of Child Support Services (DCSS), for the County of:

 
COUNTYNAME
COUNTY
(000) 000-0000

If you believe that you have no overdue support obligation or that the amount deducted is unfair or unreasonable, you should contact the Department of Child Support Services (DCSS).

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 2514-19 Rev. 2 (03-18) (INTRANET)