UI / DE 1180TP

SAMPLE, this page for reference only.

EDD Phone Numbers:
English:
1-800-300-5616
Spanish:
1-800-326-8937
Cantonese:
1-800-547-3506
Mandarin:
1-866-303-0706
Vietnamese:
1-800-547-2058
TTY (Non-Voice):
1-800-815-9387
 
Date: Blank line____ /Blank line____ /Blank line____

UNEMPLOYMENT INSURANCE CLAIM AWARD AND PAYMENT INFORMATION

Name:
Blank line 
 
Benefit Year Beginning Date:
Blank line 
Benefit Year Ends Date:
Blank line 
  • Weekly Benefit Amount:
    $Blank line 
  • Balance
    $Blank line 
  • Currently Receiving Benefits:
    Blank line 
Quarter / Year Blank space Blank space Blank space Blank space
Total Wages Blank space Blank space Blank space Blank space
Claim Payment History:
Issue Date Payment for Week Ending Date/Action Amount Paid/Reason Not Paid Issue Date Payment for Week Ending Date/Action Amount Paid/Reason Not Paid
Blank space Blank space Blank space Blank space Blank space Blank space
CONFIDENTIALITY NOTICE:
This notice is for the sole use of the intended recipients. It contains confidential or sensitive information. Under Penal Code‎ 502 and Civil Code ‎1798.53 , any unauthorized review, use, disclosure, or distribution of the content of this document is prohibited and subject to criminal penalties/fines. If you are not the intended recipient, please contact the EDD.

DE 1180TP Rev. 3 (2-18) (INTRANET) www.edd.ca.gov

SAMPLE, this page for reference only.

EDD Phone Numbers:
English:
1-800-300-5616
Spanish:
1-800-326-8937
Cantonese:
1-800-547-3506
Mandarin:
1-866-303-0706
Vietnamese:
1-800-547-2058
TTY (Non-Voice):
1-800-815-9387
ABBREVIATIONS & CODES DEFINITION
‎55-55-5 Adjustment payment
AC Additional Compensation –claim reopened
APPL Claim under appeal
BR Benefit Reduction – benefits reduced by days not able to work
CE Check Status- check cancelled
DC Desk Certification,-pending eligibility determination
DISQ Disqualified for benefits
FE Fully Employed – worked fulltime during a specific week
FS Serving false statement disqualification
RC Reopen Claim – claim reopened
SW Serving suitable work disqualification
WP Waiting Period week
XE Excessive earnings – deductible amount exceed the weekly award amount
CONFIDENTIALITY NOTICE:
This notice is for the sole use of the intended recipients. It contains confidential or sensitive information. Under Penal Code ‎502 and Civil Code ‎1798.53, any unauthorized review, use, disclosure, or distribution of the content of this document is prohibited and subject to criminal penalties/fines. If you are not the intended recipient, please contact the EDD.

DE 1180TP Rev. 3 (2-18) (INTRANET) www.edd.ca.gov