DI / DE 2514

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 

Notice of Paid Family Leave (PFL) Determination

 
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Date of Mailing or Service of Notice
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Your claim for Paid Family Leave (PFL) benefits has been denied for the period beginning Blank line and ending Blank line because:

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Basis:
EDD – Paid Family Leave PO Box 997017 Sacramento, CA 95899-7017

Phone:

1-877-238-4373

This 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 Paid Family Leave (PFL) office shown above.

DE 2514 Rev. 3 (11-18) (INTRANET)