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