Your eligibility for FEDERAL-STATE EXTENDED DURATION BENEFITS (FED-ED Extension) may be denied beginning .

On your regular claim or prior federal extension claim you were disqualified under California Unemployment Insurance Code (CUIC) Section 1257(b) for 2 to 10 weeks because you refused a job offer. The original “Notice of Determination” disqualifying you under CUIC § 1257(b) was mailed to you on . In order to be eligible for FED-ED benefits, in addition to the 2 to 10 week penalty previously assessed under CUIC § 1260(b), you are required to work at least one (1) week in full-time bona fide employment after OR earn one (1) times your weekly benefit amount in bona fide employment, which is $ , after (CUIC § 4552[d]). Refer to the “Notice of Determination for Federal-State Extended Duration Benefits” that was mailed to you when your FED-ED claim was filed.

Please MAIL, to the EDD address listed above, proof of wages such as copies of pay stubs, which includes the employer’s business name, address, phone number, dates of work or pay periods, and the gross (prior to payroll deductions) wages for the period of time you worked AFTER .

Always include your Social Security number or the EDD Customer Account Number (EDDCAN) on all documents you are submitting to the Department. In addition to sending proof of work and wages, please complete the section below with additional information regarding the employer you worked for AFTER . If you have worked for more than one employer, provide the information on the reverse side of this form or on additional sheets of paper.