UI / DE 1157WS

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 
The Great Seal of The State of California

Potential Work-sharing/UI or DI Overlap

 
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Mailing Date: MM/DD/YYYY
Week Ending Date:
MM/DD/YYYY
For Office Use Only:
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You have submitted a Work Sharing Certification DE 4581WS, for Work Sharing Unemployment Insurance benefits for the week ending date shown above. In addition, you received Disability Insurance benefits during this week.
You are not entitled to receive both Work Sharing benefits and Disability Insurance benefits during the same week. Unemployment Insurance Code Section 2628 states, "An individual is not eligible for disability benefits with respect to any period that he or she has received or is entitled to receive unemployment compensation benefits"
You must elect to receive either Work Sharing benefits or Disability Insurance benefits during the week shown above.
  1. If you elect to receive Work Sharing benefits, you cannot receive Disability Insurance benefits for any days during the same week. If you have already received Disability Insurance benefits, you may have to reimburse EDD for the Disability Insurance benefits paid.
  2. If you elect to receive Disability Insurance benefits, you cannot receive Work Sharing benefits during the same week. Your Work Sharing Certification form will not be processed; it will remain in the files at the Special Claims Office.
Please complete this form and return within 10 calendar days of mailing date shown above. If this form is not returned within 10 days, Work Sharing benefits will be paid and the Disability Insurance office will be notified of this overlap and potential overpayment.
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Department Representative
MM/DD/YYYY
Date

Please indicate your option below
(Work Sharing Benefits or Disability Benefits)

Work Sharing
Disability
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Signature
MM/DD/YYYY
Date

Special Claims Office #850 P.O. Box 419076 Rancho Cordova, CA 95741-9076 (916) 464-3300

DE 1157WS Rev. 3 (12-21) (INTRANET)