DI / DE 2578F

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NOTICE OF POTENTIAL ENTITLEMENT TO FURTHER DISABILITY INSURANCE BENEFITS

The Employment Development Department (EDD) has been reimbursed (in part or in full) for benefits previously paid to you under the Unemployment Insurance (UI) Code. If you continue to be disabled after MM/DD/YYYY, you should contact Disability Insurance (DI) at for information regarding your potential eligibility for further benefits.

DE 2578F Rev. 3 (4-21) (INTRANET)