UI / DE 8356

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 
 

Privacy Act Release Statement

I agree to the request by the California Employment Development Department for information from my former Federal employing agency which is required by law in connection with my claim for unemployment compensation, and consent to the furnishing of the requested information by my former Federal employing agency, irrespective of whether the
Privacy Act of 1974 (5 U.S.C. 552a)
would preclude the release of the information without my consent.
 
Signed
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SSA No.
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Date
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DE 8356 Rev 2. (2/17) (INTRANET)