Notice of Determination or Assessment

Detach and return this stub with your payment to:

Employment Development Department

Cashiering Group, MIC 25

PO Box 826880

Sacramento, CA 94280-0001

Section 1142

Amount: $

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Section 1144

Amount: $

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Employer Name:

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Employer Account Number:

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Claimant's Name:

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Claimant's Last 4 of the SSA Number:

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Benefit Year Began:

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Separation Date:

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Claims Interviewer Initials:

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EDD Office Number:

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Blank Space

For EDD CO/CAS Use Only

Date Mailed to Employer:

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(Issue date of assessment)

DE 3807 Rev. 5 (11-21)

Notice of Determination or Assessment

Employer Account NumberBlank line

All available information has been considered. No penalty is assessed under Section 1142 of the California Unemployment Insurance Code (CUIC).
The Department has considered all available information and found that you or your employee, officer, or willfully made a false statement or representation or willfully failed to report a material fact concerning the termination of the claimant’s employment. For text of law and petition rights, see reverse side of this notice. As required by Section 1142 of the California Unemployment Insurance Code (CUIC), you are assessed a penalty of Blank line times the claimant’s weekly benefit amount of $Blank line The total amount of the assessment is $Blank line
A formal investigation by the Department resulted in the determination that you induced, solicited, or coerced a claimant to file a false or fraudulent claim for benefits. For text of law and petition rights, see reverse side of this notice.

As required by Section 1144 of the California Unemployment Insurance Code (CUIC), you are assessed a penalty equal to the liability established against the claimant(s) involved. In addition, any charges made to your reserve account for fraudulent claim(s) filed in relation to the assessment under Section 1144, are not relieved. The total amount of the assessment is $Blank line

Reason for Decision:Blank Space

For Details About This Assessment, Please Call The EDD Office Listed On The Reverse Side Of This Notice

EDD Field Office Use Only:

Forward original to CO/CAS, MIC 3B (CAS will mail to employer). Date forwarded to CO/CAS:Blank line

Forward copy to correspondence file.

DE 3807 Rev. 5 (11-21)(INTRANET)

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