Your eligibility for FEDERAL-STATE EXTENDED DURATION BENEFITS (FED-ED Extension) may be denied beginning .

On your regular claim or prior federal extension claim, you were disqualified under California Unemployment Insurance Code (CUIC) Section 1256.4 because of an irresistible compulsion to use or consume intoxicants. The original “Notice of Determination” disqualifying you under CUIC § 1256.4 was mailed to you on . In order to be eligible for FED-ED benefits, you are required to work and earn at least five (5) times your weekly benefit amount of $ after , even if you entered into, are continuing in, or have completed a treatment program (CUIC § 4552[f]). Refer to the Notice of Determination for “Federal-State Extended Duration Benefits” that was mailed to you when your FED-ED claim was filed.

Please MAIL, to the EDD address listed above, proof of wages such as copies of pay stubs, which includes the employer’s business name, address, phone number, dates of work or pay periods, and the gross (prior to payroll deductions) wages for the period of time you worked AFTER .

Always include your Social Security number or the EDD Customer Account Number (EDDCAN) on all documents you are submitting to the Department. In addition to sending proof of work and wages, please complete the section below with additional information regarding the employer you worked for AFTER . If you have worked for more than one employer, provide the information on the reverse side of this form or on additional sheets of paper.