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DI / DE 2578FX
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SAMPLE
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CED:
MM/DD/YYYY
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NOTICE OF POTENTIAL ENTITLEMENT TO FURTHER PAID FAMILY LEAVE (PFL) 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 provide family care or bond with your minor child after
MM/DD/YYYY
, you should contact this office at
1-877-238-4373
for information regarding your potential eligibility for further benefits.
DE 2578FX Rev. 1 (11-21)
(INTRANET)
Email Address:
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