UI / DE 4800-FS (BAM)

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 
The Great Seal of The State of California

Telephone Interview Instructions

 
Date:
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SSA Number:
‎‎XXX-XX- Blank space
Last Name:
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Employment Development Department (EDD) Benefit Accuracy Measurement (BAM) Unit
 
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Important: We have scheduled a Telephone Interview for you. This is the earliest appointment available. You have the right to request more time if you need to gather information, contact witnesses, or obtain the advice of a representative. You may also mail information to the address above or fax it to _______________ Blank line . If you need to request additional time or will not be available at the time shown, please call _______________ Blank line by MM/DD/YYYY, and ask for _______________ Blank line , so we can set up another appointment for you. We will call you at the time shown. If the Department cannot reach you and more information is needed, we may send you a questionnaire.
 
Instructions:
  1. Benefits cannot be paid unless you are determined eligible, your claim form is received, and the interview is completed. During the interview, we will discuss information that you:
    If the interview involves an employer, the employer may be contacted for additional information.
  2. Interview Instructions
    You will be called by telephone: on MM/DD/YYYY between _______ Blank line and _______ Blank line.
    Please call _________ Blank line on MM/DD/YYYY between _______ Blank line and _______ Blank line.
     
    If you are calling long distance, please tell the interviewer, who will then call you back.
  3. Request for Additional Information
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DE 4800-FS (BAM) Rev. 1 (12-23) (INTRANET)

SAMPLE, this page for reference only

Mail Date:
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Benefit Year Beginning Date:
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For Office Use Only:
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Notice of Potential False Statement

Why am I receiving this notice?

You are receiving this notice because information available to the EDD indicates that you may have provided the EDD with incorrect information or withheld information related to the other potential eligibility issue that will be discussed during your scheduled phone interview.

To help you prepare for the interview, below are questions that you may be asked by the EDD. The answers you provide will help the EDD to determine if you knew or should have known that the information you were providing to the EDD was incorrect, or if you withheld information on purpose, in order to be paid unemployment benefits.

What is the penalty if EDD determines I made a false statement?

If the EDD finds that you willfully and knowingly provided incorrect information or withheld information to be paid benefits, you could receive 2 to 23 “false statement” penalty weeks. These penalty weeks will be added to your current or future unemployment claim. For each of the penalty weeks, you must be fully or partially unemployed, submit certifications, and meet all eligibility requirements, but you will not be paid benefits for those weeks. You may also have to repay any prior benefits you received and pay a monetary penalty equal to ‎30% of the total amount of benefits you were overpaid.

Can I provide the answers to these questions in writing?

If you would like to provide the answers to these questions regarding your potential false statement in writing instead of during the phone interview, you may answer the questions below, sign and date this notice, and mail it back to the address shown below within 10 days of the mail date on the Telephone Interview Instructions.

Even if you choose to respond to these questions in writing, you must still be available for the scheduled phone interview at the date and time shown on the Telephone Interview Instructions to discuss the other potential eligibility issue shown in the notice. Additionally, the EDD may contact you to clarify the answers you provide on this notice.

If you prefer to respond in writing, answer the following questions as completely as possible:

  1. Did you give us incorrect information, or withhold information from the EDD?
  2. If you provided incorrect information, did you know that the information you provided was incorrect at the time you provided that information?
  3. If you withheld information, did you know you should have provided that information to EDD at the time you provided that information?
  4. If you discovered the information you provided was incorrect, did you attempt to notify the EDD?
  5. If you answered yes to question 1, why did you provide the incorrect information or withhold the information?
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  6. Do you have any other information to add?
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I understand that state law provides for financial penalties and disqualification weeks if I intentionally make false statements or withhold important facts to obtain benefits.

I declare under penalty of perjury that the information I am providing on this notice is true and correct.

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Signature
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Printed Name
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Date
Return this completed form to:
Employment Development Department (EDD)
Benefit Accuracy Measurement (BAM) Unit
 
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DE 4800-FS (BAM) Rev. 1 (12-23) (INTRANET)