UI / DE 1447

SAMPLE, this page for reference only

 
 
Mail Date:
Blank line
For Office Use Only:
Blank line
Benefit Year Beginning Date:
Blank line
*
Blank line
 
Blank line
*
Blank line

Notice of Potential Overpayment

Our information shows that you may have been overpaid $
Blank line  
in unemployment benefits. An overpayment is when you receive benefits you are not eligible for. If you do not agree with the information on this form, you must contact us by
Blank line  
and provide the reason why you disagree. If you do not contact us, we will assume our information is correct and will mail you a Notice of Overpayment with the amount you must repay.
 
Important: If box B is checked on the bottom of this form, you can apply for an overpayment waiver. Complete and return the attached Application for Overpayment Waiver (DE 1446UI) to the address or fax number below by
Blank line  
If you do not agree with the information on this form, contact us by
Blank line  
:
  • By Mail:
    < Insert Address >
  • By Fax:
    < Insert Fax No. >
  • By Phone:
    English and Spanish:
    1-800-300-5616
    Cantonese:
    1-800-547-3506
    Mandarin:
    1-866-303-0706
    Vietnamese:
    1-800-547-2058
    California Relay Service (711): Provide the UI number
    (‎1-800-300-5616) to the operator
    TTY:
    1-800-815-9387

Our information shows that benefits were paid to you but:
Important information on other side of this notice.
DE 1447 Rev. 13 (9-22) (INTRANET)

SAMPLE, this page for reference only

Your employer has provided the following information:
Employer Name:
Employer Address:
Last Day of Work:
Reason for Separation:
Week Ending Earnings Employer Reported Earnings You Reported Benefits Paid
Blank space  $ $ $
Blank space  $ $ $
Blank space  $ $ $
Blank space  $ $ $
Blank space  $ $ $
Blank space  $ $ $
 
SUS DT:
Blank line  
(
Blank line  
)
DE 1447 Rev. 13 (9-22) (INTRANET)