UI / DE 1326 MDC

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 
Employment Development Department
PO Box 862880, MIC 40
Sacramento, CA 94280-0001
 
EDD Toll Free Phone Number:
‎1-916-654-7317 x19
Claimant Name
‎Address
City, State, ZIP Code
Mail Date:
MM/DD/YYYY

REQUEST FOR IDENTITY VERIFICATION

WHY AM I RECEIVING THIS REQUEST?

You are receiving this request because you filed an Unemployment Insurance (UI) claim or have been receiving UI benefits, and a question has been raised about your identity. Future UI benefits cannot be paid until you provide the Employment Development Department (EDD) with the information requested in this notice.

The EDD received information from the U.S. Social Security Administration (SSA) indicating that the person to whom they provided the Social Security number (SSN), and under which you filed your UI claim, has been reported as deceased. The information that the SSA provided is from their “Death Master File,” which they are required to release under the Freedom of Information Act.

WHAT DO I NEED TO DO?

If the information the EDD received from the SSA’s Death Master File is incorrect, you must take the following actions to confirm your current status with the SSA:

  1. Contact your local SSA office to obtain a document from them, such as the “Erroneous Death Case – Third Party Contact” notice, showing that the SSA’s Death Master File contained an error and that the owner of the SSN is not deceased. No other documents will be accepted to meet this requirement (e.g., Social Security Card, Driver License, U.S. Passport). The location of your local SSA office can be found on the SSA website at https://www.socialsecurity.gov/locator.
  2. Complete the signature portion of this form below by providing the 9-digit SSN that was provided to you by the SSA, printing your name, and signing and dating the form.
  3. Mail this form, along with a clear and readable copy of the SSA verification document, to the EDD at the address listed above within ten (10) calendar days from the mail date of this notice. You must include your complete SSN on each document you submit. Do not include any other forms in the envelope, as this will result in delays in processing.

FAILURE TO RESPOND WITHIN 10-DAYS WILL RESULT IN THE DENIAL OF BENEFITS

SIGNATURE BOX
The SSN provided to you by the SSA:
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I declare under penalty of perjury that the information I am providing and the documents I am submitting are true and correct and belong to me. I understand that providing false information or withholding information to receive UI benefits can be a felony. Penalties may include fines, a loss of benefits, and/or criminal prosecution.
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Printed Name
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Signature
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Date

DE 1326MDC Rev. 1 (7-18) (INTRANET)