DI / DE 2514-29

SAMPLE, this page for reference only

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

Notice of Denied Paid Family Leave (PFL) Benefits ‑ Claim Date Adjusted to First Day Care Needed

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

We are unable to pay you Paid Family Leave (PFL) benefits from MM/DD/YY through MM/DD/YY because:

Your claim cannot begin before the day on which the physician/practitioner certified you were needed to provide care for your family member. Therefore, the beginning date of your claim has been adjusted.

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 2514-29 Rev. 2 (03-18) (INTRANET)