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EDD Employment Development Department State of California Logo

Employment Development Department

IAD MIC 16 – Federal Unit

PO BOX 3490

Rancho Cordova CA 95741-3490

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REQUEST FOR ADDITIONAL INFORMATION FOR FEDERAL CLAIM

Date:

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The enclosed Claimant’s Affidavit of Federal Civilian Service, Wages and Reason for Separation (ETA 935), is being returned for additional information for the reason(s) checked below:

The quarterly wage totals are missing. Refer to Item 8c on the ETA 935 form. You must supply the quarterly wage amounts.

The documentary evidence of wages is missing. Refer to Item 8c on the ETA 935 form.

Acceptable forms of documentary evidence include:

W-2 Form
Pay stubs for the period shown
SF-50, Notification of Personnel Action

Your signature is missing. Refer to Item 9 on the ETA 935 form.

Other

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If you have questions regarding the above, please call ‎1-916-464-0865.

You may fax the ETA 935 with the requested information to ‎1-916-449-1595 or mail it to the above address.

DE 239FEDA Rev. 2 (2-18) (INTRANET)

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UI / DE 239FEDA

REQUEST FOR ADDITIONAL INFORMATION FOR FEDERAL CLAIM