DI / DE 2514-45

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 Suspended Paid Family Leave (PFL) Benefits - Physician/Practitioner Convicted

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

We have suspended your Paid Family Leave (PFL) benefits from MM/DD/YY through MM/DD/YY because:

The physician/practitioner certificate that you submitted was signed by a physician/practitioner who is licensed by and practices in a foreign country and who has been convicted within the past five years of filing false claims with the Department.

Basis : California Unemployment Insurance Code (CUIC), section 2708

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 2514-45 Rev. 2 (03-18) (INTRANET)