REQUEST FOR IDENTITY INFORMATION

Mail Date:

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For Office Use Only:

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BYB:

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This notice is to advise you that the Employment Development Department (EDD) is unable to confirm your identity as required by unemployment insurance regulations.

You must submit a legible copy of your birth certificate that was issued by a local, state, or federal agency, or a foreign government, or another official certification of birth.

You must submit a legible copy of your Blank line document to verify your identity. The copy of the document you submitted on MM/DD/YY to verify your identity was illegible or unusable for the following reason:

Document was illegible because the document was too small. (Please enlarge the document by 50% before re-sending.)

Document was illegible because the document was too dark. (Please decrease the darkness on the copy machine before re-copying the document and re-sending.)

Document was illegible because of a poor quality photocopy. (Please ensure the copy is clear and readable before re-sending.)

Document was unusable because it was damaged and/or part(s) of the document was missing. (Documents used for identity verification must contain all of the information as required by law.)

Please mail a clear and legible copy of the requested document to the EDD address listed below. If the document is not received within 10 days from the mail date on this form, a decision on your eligibility to receive unemployment insurance benefits will be made based on the available information. Failure to comply within 10 days from the date of this notice could result in a denial of benefits. Please include your name and Social Security Number on any documentation you mail to the EDD.

If you have questions about this request, you can call EDD toll-free at

‎1-866-401-2849.

Mailing Address:

Employment Development Department

PO BOX 2530

Rancho Cordova, CA 95741-2530

DE 4365RID Rev. 3 (8-21)

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UI / DE 4365 RID

REQUEST FOR IDENTITY INFORMATION