UI / DE 1180PH

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: MM/DD/YYYY

UNEMPLOYMENT INSURANCE CLAIM STATUS AND PAYMENT HISTORY

Name:
Blank line 
Benefit Year Beginning Date:
Blank line 
Benefit Year Ending Date:
Blank line 
  • Maximum Benefit Amount:
    $Blank line 
  • Weekly Benefit Amount:
    $Blank line 
  • Balance
    $Blank line 
  • Currently Receiving Benefits:
    Blank line 
  • BulletBenefits on this claim are exhausted. You may qualify for a new claim when your benefit year ends. Please contact the Department 1-5 days prior to Blank line______ to determine if you are eligible for a later claim.
  • BulletBenefits not paid due to eligibility still pending.
  • BulletBenefits reduced or denied for a fixed disqualification period.
  • BulletBenefits denied due to an indefinite disqualification.

(For additional information, refer to Notice of Determination, DE 1080, previously issued.)

Claim Payment History:
(See explanation of abbreviations and codes on last page.)
Issue Date Payment for Week Ending Date/Action Amount of Deductible Earnings Amount Paid/ Reason Not Paid Serial Number/ Payment Status Comments: Child Support, Wages, etc.
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 1180PH 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
13 Payment status – payment cancelled
55-55-5 Adjustment payment
AC Additional claim – claim reopened, intervening employment
APPL Claim under appeal
BR Benefit Reduction – benefits reduced by days not able to work
CE Payment status – payment cancelled
CSI Child Support Intercept – benefits reduced
DC Desk Certification, pending eligibility determination
DISQ Disqualified for benefits
ER Earnings reported by claimant
FE Fully Employed
FS Serving disqualification for making false statement
OE Check Status – check still outstanding
OP Overpayment – benefits reduced to pay overpayment amount due
PROC Payment Status – payment issued, check number in process
PWP Receipt of deductible pension
RB Electronic Benefit Payment (EBP)
RC Reopen claim – claim reopened, no intervening employment
RC Check Status/Comments – replacement check
RE Check Status – check reconciled (cashed)
SW Serving disqualification for failure to accept suitable work
T Subsequent payment with same serial number transferred to another claim
Transfer Payment transferred to the proper claim
V Voluntary Federal Income Tax (VFIT) Withholding
WC Receipt of deductible temporary worker’s compensation
WP Waiting Period week
WS Work Share reduction
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 1180PH Rev. 3 (2-18) (INTRANET) www.edd.ca.gov