UI / DE 1447TRA

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 

 

NOTICE OF POTENTIAL WAIVER - TAA/TRA

FOR OFFICE USE ONLY:
Blank line 
DATE:
Blank line 
NAME:
Blank line 
As a result of
Blank line
, it has been determined that you were overpaid benefits during the period
Blank line
; or
Blank line
allowance and you have an overpayment of $
Blank line
As it has not been determined that fraud or fault was involved in causing this overpayment, you have the right to request that the Department waive repayment, based upon extraordinary financial hardship. (Title 20, CFR, Section 617.55)
If you request that the Department waive the requirements to repay this overpayment, you must complete and return the enclosed forms.
  1. Confidential Financial Statement
  2. Record of Potential Family Income for the Next Three Months
If you do not respond to this letter within ten days, we will assume that you do not request a waiver and will bill you for this overpayment.
The overpayment does not affect your rights to claim benefits if you are unemployed.
Blank line 
Department Representative
Blank line 
Field Office Stamp
DE 1447TRA Rev. 4 (10-21) (INTRANET)