UI / DE 1101CLMT

SAMPLE, this page for reference only.

EDD Call Center
PO Box
CITY, STATE ZIP CODE
 
Mail Date:
MM/DD/YYYY
For Office Use Only:
00000
Customer Phone #:
(000) 000-0000
CLAIMANT'S NAME
CLAIMANT'S ADDRESS
CITY, STATE ZIP CODE
EDD Telephone Numbers:
English and Spanish:
1-800-300-5616
Cantonese:
1-800-547-3506
Mandarin:
1-866-303-0706
Vietnamese:
1-800-547-2058
TTY (non-voice):
1-800-815-9387
 
edd.ca.gov

Unemployment Insurance Claim Filed

You applied for unemployment benefits and your claim was filed starting.

You provided the below information:

  • Your last employer was:
     
    Employer's Name
     
    Employer's Address City,
     
    State and ZIP Code
  • The last day you worked for this employer was MM/DD/YYYY.
    The reason you are no longer working for this employer is: (Reason given when you filed your claim).
  • You (are/are not) receiving a pension or other income that may be deductible from your unemployment benefits.
  • You (are/are not) able and available to accept full-time work.
  • You (have/do not have) the legal right to work in the United States.

Review the above information carefully.

No action is required if the information is correct. We consider this information correct unless you report otherwise within 10 days from the mail date on this form. Any response after 10 days may result in delay of benefits. To report other information, include your name and Social Security number. You can mail your response to the EDD address above. Or you can call us at one of the above telephone numbers.

Federal and state laws prohibit us from revealing information about your employment or unemployment claim to your spouse, relatives, friends, non-interested parties, and private interest groups. Federal legislation does require the information be made available to state and federal welfare, medical assistance, CalFresh, housing, and child support enforcement agencies.

You have the option to cancel your unemployment claim. Refer to your Notice of Unemployment Award (DE 429Z) for cancellation requirements. If you want to cancel your claim, do not certify for benefits. Once you are paid benefits, you won’t be able to cancel your claim.

If you are eligible for benefits, you can receive them through a direct deposit, prepaid debit card, or by check. Refer to the Unemployment Insurance Benefits: What You Need to Know (DE 1275B) for more information or visit edd.ca.gov. If you were previously issued a debit card and need a replacement, contact Money Network Debit Card Customer Service toll-free at ‎1-800-684-7051.

DE 1101CLMT Rev. 9 (8-24) (INTERNET)