UI / DE 17C

SAMPLE, this page for reference only

EDD
PO BOX 989735
West Sacramento, CA 95798-9735

EDD Employment Development Department State of California Logo

Blank Box  
EDD Phone Numbers:
Unemployment Insurance:
English:
1-800-300-5616
Spanish:
1-800-326-8937
Cantonese:
1-800-547-3506
Mandarin:
1-866-303-0706
Vietnamese:
1-800-547-2058
TTY (Non-voice):
1-800-815-9387

Notice of Determination on Combined Wage Claim

Mail Date:
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Date of Claim:
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EDD Office Number:
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For Office Use Only:
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Prepared By:
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The Employment Development Department (EDD) has processed your request for a Combined Wage Claim for Unemployment Insurance. Please see below. Call EDD if you have any questions. Our toll-free telephone numbers are listed above.
  3. For your information, you are separately eligible for a monetary award in another state.
    A.State Blank space 
    B. Award Blank space 
    C. Per week Blank space 
(Since you are monetarily eligible in another state, you have the right to request cancellation of this Combined Wage Claim at any time within the Benefit Year; provided you repay any benefit payments issued which were based on this claim.)
 
Reason:
  2. Wages from the employer were not transferred by the other state for the base period claimed.
    A. Employer Blank space 
    B. State Blank space 
    C. Base period
    Blank line to Blank line
    D. Comments: Blank space
  3. The wages transferred from the other state do not increase the monetary award on the California claim. Therefore, there is no reason to transfer in the wages from the other state.
    A. Award Blank space 
    B. Per week Blank space 
  4. You have a maximum California award and there is no reason to transfer in the wages from the other state because it will not increase the California award.
     
     
  6. You have an existing valid claim filed in Blank line that still has a monetary balance.
    A. Benefit year ending Blank space 
    B. Balance Blank space 
  7. Your California claim is being cancelled. No further benefits can be paid on your California claim. Please call EDD for assistance to reopen your out-of-state claim.
     
     

Refer to the reverse side of this notice for appeal rights and other important information

DE17C Rev. 15 (12-22) (INTRANET)

SAMPLE, this page for reference only

    4. For a claim to be valid in California, a claimant must have earned as least $1,300 in one quarter during the base period, or at least $900 in the high quarter and 1.25 times the high quarter earnings during the base period. (For example: $900 x 1.25 = $1125. The claimant must earn $225 in addition to the $900 earned in the high quarter during the base period for the claim to be valid.)
  6.  

Appeal for Out-of-State Wages

  1. To request an investigation of out-of-state wages, you must file an Interstate Request for Reconsideration (IB 14) and mail it to the other state or states. To file the IB 14, please call EDD using the toll-free numbers listed on the first page of this notice.
     
    You will need to mail proof of base period wages such as dated check stubs, W-2s, etc, when mailing the IB 14 to the other state or states.
     
    The base period of your claim is from Blank line to Blank line
     
    Be sure to include your Social Security Number on each item.
     
    Under Title 20 of the Code of Federal Regulations (20 CFR 616.8), request for redetermination or appeal involving the employment or wages subject to transfer shall be decided by the transferring State in accordance with its laws.

Protest or Appeal for California Wages

  1. Under Sections 1332B and 2707.5B of the California Unemployment Insurance Code, the Employment Development Department has the authority to reconsider or recompute an Unemployment Insurance Claim.
  2. To file an appeal, complete the enclosed Employment Development Department Appeal Form (DE 1000M) and mail the form to:
    Blank Box
     
You may obtain assistance in filing an appeal by calling EDD using the toll-free telephone numbers listed on the first page of this notice.
DE17C Rev. 15 (12-22) (INTRANET)