UI/DE 1326T

SAMPLE, this page for reference only

Employment Development Department
P.O. Box 2530
Rancho Cordova, CA 95741-2530
Toll-Free Phone Number: 1-866-401-2849

EDD Employment Development Department State of California Logo

REQUEST FOR IDENTITY INFORMATION REGARDING AN OVERPAYMENT DEBT

Claimant Name
Claimant Mailing Address
Claimant City, State, ZIP
Mail Date: MM/DD/YYYY
For Office Use Only:

You contacted the Employment Development Department (EDD) about a California Unemployment Insurance (UI) overpayment debt that you state does not belong to you because you did not file a UI claim effective MM/DD/YYYY or you did not receive the overpaid UI benefits. In order for the EDD to determine who filed the claim and was overpaid UI benefits, you must mail copies of the identity verification documents requested on page 2 of this notice along with this completed form in the enclosed envelope within 10 calendar days.

The overpayment debt will remain on your records with the EDD unless you send this completed form and as many documents as possible that prove that you did not receive UI benefits. Until the debt is paid in full, collection efforts will continue that may include offsets of future UI and Disability Insurance (DI) benefit payments, wage garnishment, and referralto federal and state agencies for collection of the amount owed from future income tax refunds, State of California lottery winnings, and unclaimed property funds.

PLEASE PROVIDE THE FOLLOWING IDENTITY INFORMATION:
The last four digits of the Social Security number that was used to file this claim are:
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Other Social Security numbers you have used:
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Full name (as it appears on your Social Security Card):
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First
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Middle
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Last
Other names you have used:
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YOU MUST CHECK ALL BOXES BELOW THAT APPLY TO YOU:
PLEASE PRINT ALL EMPLOYER NAMES YOU WORKED FOR DURING THE YEAR(S)
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:
If you don’t have enough space, please use an additional page.
Employer name:
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Employer name:
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Employer name:
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Employer name:
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Employer name:
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Employer name:
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PLEASE PRINT ALL ADDRESSES THAT YOU USED DURING THE YEAR(S)
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:
Please begin with your most recent mailing or residential address (including the full street address, city, state, and ZIP code). If you don’t have enough space, please use an additional page. 
Period of time:
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Address:
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Period of time:
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Address:
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Period of time:
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Address:
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Period of time:
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Address:
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SIGN AND RETURN THIS DOCUMENT WITHIN 10 CALENDAR DAYS FROM THE MAIL DATE OF THIS FORM.

Use the envelope provided, enclose all requested identity verification documents, and include your complete Social Security number on each document you submit (Refer to page 2 for a description of identity documents you can provide).

By signing below you agree to the following statement: I understand the law provides penalties if I make false statements or withhold facts to obtain benefits; I declare under penalty of perjury that the information I am providing is true and correct.

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Signature
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Date
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Phone number

DE 1326T Rev. 1 (3-22) (INTERNET)

SAMPLE, this page for reference only

ACCEPTABLE DOCUMENTS FOR IDENTITY VERIFICATION

You must send a copy of ONE document from the “Photo Identification” column AND copies of as many of the requested documents as you can provide from the "Other Identity Documents “column below. The overpayment debt will remain on your records with the EDD unless you send sufficient documents that prove that you did not receive the UI benefits. All copies should be printed on 8½” x 11” paper and you must write your Social Security number on each page.

PHOTO IDENTIFICATION
Provide a clear and readable copy of ONE of the following documents.		 OTHER IDENTITY DOCUMENTS
Provide a clear and readable copy of ALL of the following documents with the check box marked.
  • Driver license or ID card issued by a state, local, or federal agency that contains your name, your date of birth, and your photograph.
  • Official document issued to you by a state, local, or federal agency that contains your name, your date of birth, and your photograph.
  • U.S. Passport or U.S. Passport Card that contains your name, your date of birth, and your photograph.
  • U.S. Military card that contains your name, your date of birth, and your photograph (front and back).
  • Military dependent’s ID card that contains your name, your date of birth, and your photograph (front and back).
  • Alien Registration or Permanent Resident Card (Form I-551) issued by the U.S. Citizenship and Immigration Services that contains your name, your date of birth, and your photograph.
  • Certificate of Naturalization (Form N-550).
  • Employment Authorization Document (Form I-766) issued by the U.S. Citizenship and Immigration Services that contains your name, your date of birth, and your photograph.

Employment Data

  • Your first name or initial and your last name, and
  • Your Social Security number (or at least the last four digits) or your employee identification number, and
  • The name of your employer, and
  • The date or pay period the check stub or pay statement was issued.

Address Verification

Social Security number Verification

Date of Birth Verification

Marriage Certificate (if applicable)

 

Proof of Identity Theft

  • Police reports.
  • Credit agency reports.
  • California Franchise Tax Board (FTB) reports.
  • Internal Revenue Service (IRS) reports.
  • Social Security Administration reports.

 

If additional documentation is required, the EDD will contact you.

Employment Development Department • P.O. Box 2530, Rancho Cordova, CA 95741-2530 • 1-866-401-2849

DE 1326T Rev. 1 (3-22) (INTERNET)