UI / DE 3394

SAMPLE, this page for reference only

DETERMINATION ON CLAIMANT’S REQUEST FOR RECONSIDERATION OF WAGES

Name: Blank space  For Office Use Only:Blank space 
Address: Blank space  Date Of Claim:Blank space 
Date Of Issue: Blank space 
Prepared By: Blank space 
This is in reference to your Request for Reconsideration for Transfer of Wages (IB14)
Wages have not been transferred to Blank Line__________________for the reason(s) checked below.
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    You may appeal the denial of the California wages to an Administrative Law Judge of the California Unemployment Insurance Appeals Board within 30 days from the mailing date of this notice and provide any additional information not previously made available to the Department.
To file an appeal, you may return a copy of this document and complete the enclosed EMPLOYMENT DEVELOPMENT DEPARTMENT APPEAL FORM (DE 1000M) and mail the form to:
Combined Wage Transferring Unit
Employment Development Department (EDD)
Unemployment Insurance Integrity and Accounting Division – MIC 16
P.O. Box 826880
Sacramento, CA 94280-0001
 

DE 3394 Rev. 14 (3-22) (INTRANET)