DI / DE 2517-58

SAMPLE, this page for reference only

DISABILITY INSURANCE
PO BOX 469
LONG BEACH CA 90801-0469
SAMPLE CLIENT
‎1234 ANY STREET
ANY CITY
 

Notice of Reduced State Disability Insurance (SDI) Benefits Court-ordered Child Support Obligation

 
MAILING DATE:
MM/DD/YY
CLAIM EFFECTIVE DATE:
MM/DD/YY
We have reduced your State Disability Insurance (SDI) benefits beginning MM/DD/YY because:
Records indicate that you have an unpaid, court-ordered, child support obligation. An amount up to‎ 25% of the benefits due you after all other reductions have been made shall be withheld and forwarded to the California Department of Child Support Services (DCSS) until we are notified that your obligation has been satisfied.
Basis: California Unemployment Insurance Code (CUIC), section 2630.
If the amount withheld is less than your monthly support obligation, the overdue and unpaid total will increase.
Any question you have concerning your support obligation should be directed to the Department of Child Support Services (DCSS) for the County of:
ANY COUNTY
Telephone: ‎(000) 000-0000
If you believe that you have no overdue support obligation or that the amount deducted is unfair or unreasonable, you should contact the Department of Child Support Services (DCSS).
Communications dealing solely with your Disability Insurance (DI) claim should include your Social Security number and be addressed to the Disability Insurance (DI) office shown at the top of this page.
This determination is final unless you send a written appeal within thirty (30) 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 2517-58 Rev. 5 (03-18) INTRANET