DI / DE 2514-05

SAMPLE, this page for reference only.

EDD - PAID FAMILY LEAVE
PO BOX ‎997017
‎SACRAMENTO CA 95899-7017
SAMPLE CLIENT
1234 ANY STREET
ANY CITY
 

Notice of Denied Paid Family Leave (PFL) Benefits – Entitled to Unemployment Insurance (UI) Benefits

 
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:
You have received or are entitled to receive Unemployment Insurance (UI) benefits for the same period covered by your claim.
Basis: California Unemployment Insurance Code (CUIC), section ‎3303.1 (a) (1).
This determination is final unless you send a written appeal within thirty (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 above.

Notice of Determination

DE 2514-05 Rev. 2 (03-18) (INTRANET)