DI / DE 2514-16

SAMPLE, this page for reference only

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

Notice of Continued Paid Family Leave Claim Determination

Mailing Date:
MM/DD/YY
Claim Effective Date:
MM/DD/YY

The recent Paid Family Leave (PFL) claim you filed has been determined to be a continuation of your claim period that began MM/DD/YY.

Your maximum benefit amount for this benefit period is $00,000.00 After subtracting the amount of benefit payment(s) already made to you, your balance is $00,000.00

Basis:
California Unemployment Insurance Code (CUIC), section 3301(c)(d).

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 2514-16 Rev. 2 (03-18) (INTRANET)