DI / DE 6314

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo
CED:
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Mailing Date:
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Office Number:
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Form Code:
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Notice of Incomplete Appeal

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We have received from you a
without a written appeal.
If you do not wish to appeal, please disregard this notice.
If you wish to appeal the Notice of Determination mailed to you on BlankLine, complete the enclosed Appeal Form and submit it with the enclosed Notice of Right to Continue Disability Benefits Pending Appeal ‎‎(DE 6315D) Notice of Right to Continue Paid Family Leave (PFL) Benefits Pending Appeal ‎‎(DE 6315DF) within 30 days of the original mailing date of the Notice of Determination (shown above). If we do not receive an appeal from you within 30 days of the original mailing date of the Notice of Determination and you requested benefits to continue pending a decision on your appeal, benefits cannot be paid.
For additional information, please read the enclosed notice. If you have any questions, please contact:
Disability Insurance Office Paid Family Leave Office
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Phone: ‎ 1-800-480-3287 ‎ 1-877-238-4373

DE 6314 Rev. 4 (6-21) (INTRANET)