UI / DE 17 (BAM)

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

Date:
Blank line 
 
Blank box
SSA Number:
‎‎XXX-XX- Blank space
Batch Number:
Blank line 

Final Notice

  • You were not available for an Employment Development Department (EDD) Benefit Accuracy Measurement (BAM) telephone interview on
    Blank line
  • Therefore, your benefits have been suspended effective
    Blank line
    , pending receipt and review of the questionnaire and explanation for your failure to report to the interview.

Completion of this questionnaire is required by department regulations. Failure to return the questionnaire may result in disqualification and loss of benefits under California Unemployment Insurance Code (CUIC) Section 1253A*.

(*An unemployed individual is eligible to receive unemployment compensation benefits with respect to any week only if the Director finds that: A claim for benefits with respect to that week(s) has been made in accordance with authorized regulations.)

Please include a copy of the following documents:

  • Please provide a full explanation below for your failure to report to the interview and/or complete this questionnaire. Your explanation will determine whether you are entitled to benefits now and in the future.Blank Space
  • You have ten (10) days from the date of this document to return the questionnaire with a copy of the above documents and an explanation on why you were not available. The BAM Section will determine your eligibility based on all information received. If you have any questions or need assistance, please call the BAM Unit at
    Blank line

Thank you for your cooperation.

Blank line 
BAM Analyst #
Blank space

DE 17 (BAM) Rev. 1 (12-23) (INTRANET)