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EDD Employment Development Department State of California Logo

Special Claims Office 850 • P.O. Box 419076 • Rancho Cordova, CA 95741-9076

Notice of Eligibility for Relocation Allowances, Trade Act of 1974, as Amended

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Social Security No.: ‎‎XXX-XX- Blank space
Petition No.: Blank space
Date of Request: MM/DD/YYYY
Field Office No.: Blank space

Social Security No.: ‎‎XXX-XX- Blank space

Petition No.: Blank space

Date of Request: MM/DD/YYYY

Field Office No.: Blank space

Caption
Question	Answer
1. You are eligible to receive Relocation Allowances. You MUST begin the relocation within 182 days of the date of your application or within one year of your application if good cause has been shown for the extended period. (19 USC 2298, 20 CFR, Sections 617.40 - 617.48.)
Your eligibility to receive Relocation Allowances has been extended to MM/DD/YYYY. (19 USC 2298, 20 CFR, Sections 617.42 and 617.43.)
2. Relocation Allowances are approved for payment of the following cost: Advance PMT Final PMT (computation detailed on reverse)
(A)	Lodging and Meals of	$ Blank line
	Computed at ‎90% of the lesser of:
	(1)$ Blank Line actual expenses, or (2)$ Blank Line ‎50% of Federal daily living allowances.
(B)	Travel Expense at	$ Blank line
	Computed at ‎90% of total of:
	(1) $ Blank Line at $ Blank Line per mile. for Blank Line privately owned automobile(s).for Blank Line miles.	(2) $ Blank Line for airfare. $ Blank Line for busfare. $ Blank Line for trainfare.
(C)	Lump Sum of	$ Blank line
	Computed at 3 × $ Blank Line (average weekly wage) not to exceed $800, $1,250 for petitions filed on or after November 4, 2002.
(D)	Moving Allowance of	$ Blank line
	Computed at ‎90% of:
	(1) $ Blank Line for cost of commercial carrier, or trailer hauled by commercial carrier, or rental trailer, or truck. (2) $ Blank Line computed at $ Blank Line per mile for Blank Line miles for trailer or house trailer hauled by automobile.	(3) $ Blank Line to Commercial Carrier Commercial Carrier’s Address: Blank line Blank line Blank line
Total Amount Paid	$ Blank line

1. You are eligible to receive Relocation Allowances. You MUST begin the relocation within 182 days of the date of your application or within one year of your application if good cause has been shown for the extended period. (19 USC 2298, 20 CFR, Sections 617.40 - 617.48.)

Your eligibility to receive Relocation Allowances has been extended to MM/DD/YYYY. (19 USC 2298, 20 CFR, Sections 617.42 and 617.43.)

2. Relocation Allowances are approved for payment of the following cost:

Advance PMT Final PMT

(computation detailed on reverse)

(A)

Lodging and Meals of

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Computed at ‎90% of the lesser of:

(1)$

Blank Line

actual expenses, or

(2)$

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‎50% of Federal daily living allowances.

(B)

Travel Expense at

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Computed at ‎90% of total of:

(1)

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at $

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per mile. for

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privately owned automobile(s).for

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miles.

(2)

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for airfare. $

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for busfare. $

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for trainfare.

(C)

Lump Sum of

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Computed at 3 × $

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(average weekly wage) not to exceed $800, $1,250 for petitions filed on or after November 4, 2002.

(D)

Moving Allowance of

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Computed at ‎90% of:

(1)

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for cost of commercial carrier, or trailer hauled by commercial carrier, or rental trailer, or truck.

(2)

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computed at $

Blank Line

per mile for

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miles for trailer or house trailer hauled by automobile.

(3)

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to Commercial Carrier Commercial Carrier’s Address:

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Total Amount Paid

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APPEAL RIGHTS (Please Read Carefully)

You have the right to file an appeal if you do not agree with all or part of this decision. To appeal, you must write a letter stating that you want to appeal. Explain why you do not agree with the decision. Write your Social Security number on your letter. (Title 22, California Code of Regulations, Section 5022.) Mail your letter to the address shown above. (Title 22, California Code of Regulations, Section 5023 and 20 CFR, Section 617.51.) File your appeal within 30 days of the mail date of this notice or no later than MM/DD/YYYY.

When your appeal is received, your case will be reviewed. If the decision is still the same, we will send your appeal to the Office of Appeals. If you appeal after 30 days, you must show good cause for the delay or the Administrative Law Judge may dismiss your appeal.

The Office of Appeals will send you a letter with the date, place, and time of your hearing. At the hearing, the Administrative Law Judge will listen to you, examine the facts, and make a decision. You may bring a representative or someone for assistance. For more information or help with your appeal, please call the EDD Special Claims Office at ‎888-697-1760.

While your appeal is pending, you must continue to mail any moving estimates and/or receipts for which you are requesting reimbursement on your relocation. If you do not receive any response or a hearing letter, contact the EDD Special Claims Office at ‎888-697-1760. If the judge decides you can be paid, we can only pay if moving estimates and/or receipts were received.

Interviewer/

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Initials

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Date Signed

DE 8321A Rev. 9 (3-22) (INTRANET)

SAMPLE, this page for reference only

EXPLANATION AND/OR RECONCILIATION OF RELOCATION ALLOWANCES

Travel Expense Privately owned auto (Lesser of ‎90% actual or ‎‎50% Fed. prevailing mileage rate)	Estimated Costs	Amounts Advanced (@ 90%)	Adjustments and Final Payments
	Estimated Costs	Amounts Advanced (@ 90%)	Actual Final Cost	Amount Payable at Fed. Standard or ‎ 90% Actual	Amount Underpaid	Amount Overpaid
Car no. 1, no. of miles Blank Line_____ at Blank Line_____ per mile Car no. 2, no. of miles Blank Line_____ at Blank Line_____ per mile Other ——— no. of miles Blank Line_____ at Blank Line_____ per mile Commercial Carrier: Name: Blank Line_______________________________ Airfare Blank Line ___________ Busfare Blank Line ___________ Trainfare Blank Line _________	$	$	$	$	$	$
Moving Allowance (‎90% actual expense) Commercial Carrier: Blank Line_____________________________ Trailer hauled by commercial carrier: Blank Line_____________________________ Trailer or truck rental: Blank Line_____________________________ House trailer or trailer hauled by privately owned auto:	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space
Lodging and Meals (‎90% actual or ‎50% Federal per diem) Lodging Meals	Blank space	Blank space	Blank space	Blank space	Blank space	Blank space
Lump Sum Payment (3 x Average weekly wage) (Not to exceed $1,250).			$	$	$	$
TOTALS			$	$	$	$

Question	Answer
Blank line Department Representative	Blank line Date

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Department Representative

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Date

DE 8321A Rev. 9 (3-22) (INTRANET)

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UI / DE 8321A

Notice of Eligibility for Relocation Allowances, Trade Act of 1974, as Amended

EXPLANATION AND/OR RECONCILIATION OF RELOCATION ALLOWANCES