DI / DE 2514-68

SAMPLE, this page for reference only.

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

Notice of denied paid family leave benefits - military rest and recuperation leave more than 15 days

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 through when eligible because:
Taking leave for the purpose of accompanying an eligible family member who is on short term, temporary, rest and recuperation military leave may not exceed 15 calendar days from the beginning date of the military family member’s rest and recuperation leave.
Basis:
California Unemployment Insurance Code (CUIC), Section 3302.2(f)

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 Employment Development Department (EDD) office shown above.

DE 2514-68 (12-20) (INTRANET)