DI / DE 2514-12

SAMPLE, this page for reference only

EDD - PAID FAMILY LEAVE
PO BOX 997017
SACRAMENTO CA 95899-7017
SAMPLE CLIENT
‎1234 ANY STREET
ANY CITY CA 99999-9999
 

Notice of Denied Paid Family Leave (PFL) Benefits - Full Wage Continuation

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:

Your employer has continued your full regular wages. PFL pays benefits only when there is a wage loss.

Basis:
California Unemployment Insurance Code (CUIC), section 2656.
When your employer stops or reduces your wages, immediately contact the Employment Development Department (EDD) at the phone number listed above.

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 2514-12 Rev. 4 (12-20) (INTRANET)