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DI / DE 2517RD
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SAMPLE
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Claim ID:
Blank Line
Mailing Date:
Blank Line
Office Number:
Blank Line
Notice of Reconsidered Disability Insurance (DI) Determination
Based on additional information received, the Employment Development Department (EDD) has taken action on your Disability Insurance (DI) claim as follows:
The Notice of Determination mailed to you on
MM/DD/YYYY
has been reversed. Your claim for Disability Insurance (DI) benefits has been allowed for the period beginning
MM/DD/YYYY
.
Basis:
California Code of Regulations (CCR), title
22
, section
Blank Line
California Unemployment Insurance Code (CUIC), section
Blank Line
The Notice of Determination mailed to you on
MM/DD/YYYY
has been changed. Enclosed is a corrected notice.
Basis:
California Code of Regulations (CCR), title
22
, section
Blank Line
California Unemployment Insurance Code (CUIC), section
Blank Line
This determination is final unless you send a written appeal within thirty (30) days from the mailing date above. You may appeal this redetermination by completing the enclosed Appeal Form or by 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 below.
Any benefits owed to you have been or will be sent separately.
If you have questions regarding this notice, call
Blank Line
Blank Line
Disability Insurance (DI) Claims Representative
Employment Development Department (EDD)
Select to resubmit a
DE 1000AA
(English/Spanish)
DE 2517RD Rev. 12 (5-21)
(INTRANET)
Email Address:
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