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Notice of Potential Overpayment of Paid Family Leave (PFL) Benefits

If you disagree with the preceding information, please provide us with any facts that will help us determine if you were, in fact, not overpaid.

If you agree with the information and believe you were overpaid but do not believe that you should be required to repay us you will need to take the following steps:

• Complete and return the enclosed financial statement (form DE 1446), and
• Submit a letter telling us why you believe this potential overpayment was not due to fraud, misrepresentation, or willful nondisclosure on your part and/or received without fault on your part.
• State whether you made changes in your financial status or circumstances (commitments) that you would not have made had you not received the benefits paid to you and if repayment would impose extraordinary hardship on you or your family.

All of this information will be evaluated to determine whether repayment is required.

If you agree that you were overpaid PFL benefits but cannot fully repay us at this time, please complete and return the enclosed financial statement form (DE 1446). This information will be used to establish a repayment schedule.

If you agree with the above information and/or do not respond to this letter within 10 days, we will establish the overpayment and mail the Notice of Overpayment, DE 4400F. We will determine if you were or were not at fault and consider administrative penalties based on available facts.

This is not a bill. Do not submit any payment unless you receive a formal Notice of Overpayment, DE 4400F.

DE 1447F (11-23) (INTRANET)