UI / DE 1447FED

SAMPLE, this page for reference only

Employment Development Department
UI Center Anaheim
‎PO Box 66000
Anaheim, CA 92816-6000

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EDD Toll-Free 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
Mail Date:
MM/DD/YYYY

NOTICE OF POTENTIAL OVERPAYMENT OF UNEMPLOYMENT BENEFITS FOR FEDERAL GOVERNMENT EMPLOYEES

You are receiving this notice because Employment Development Department (EDD) records show that you are a federal employee who filed for California Unemployment Insurance (UI) benefits during the federal government shutdown that began on December 22, 2018, and ended on January 25, 2019, and you have received or will receive backpay.

Typically, you will have to repay any UI benefits you were paid if you received wages from your employer for the same time period in which you received benefits. However, California law does allow the EDD to waive the repayment requirement if certain financial criteria are met.

Complete Sections A and B of this notice and return it to the EDD in the enclosed envelope by MM/DD/YYYY This information will be used to determine if you will be required to repay the UI benefits and the amount owed. If you do not respond to this notice by MM/DD/YYYY, the EDD will determine that you were fully employed and have received, or will receive, backpay for the government shutdown period, and you will receive a Notice of Overpayment with the amount you will be required to repay the EDD.

Repayment Waiver

To be considered for a waiver of the benefit amount you may have to repay, you must complete the enclosed Personal Financial Statement and return it with this completed notice in the enclosed envelope. You will then receive a Notice of Overpayment, which will indicate the amount you will need to repay or if your waiver was approved. You do not need to submit any payment until you receive the Notice of Overpayment.

Repayment Arrangements

Once you receive a Notice of Overpayment, the EDD will work with you on the repayment. You may repay benefits by an Automated Clearing House (ACH) debit or credit card, or by mail. You may also set up a repayment plan. The Notice of Overpayment will provide you with more information.

Continued on Back of Form

DE 1447FED (3-19) (INTRANET)

SAMPLE, this page for reference only

The following information must be submitted to the EDD to determine your repayment amount, if any. If you do not respond to this notice by MM/DD/YYYY, the EDD will determine that you were fully employed and have received, or will receive, backpay for the government shutdown period, and you will receive a Notice of Overpayment with the amount you will be required to repay the EDD.

Section A: Complete this questionnaire.

  1. Were you furloughed or did you work without pay as a result of the federal government shutdown from December 22, 2018, through January 25, 2019?
    1. If you answered “no,” proceed to Section B. Please note: If you do not return this notice, you will be required to repay the UI benefits and you will receive a Notice of Overpayment by mail.
    2. If you answered “yes,” complete both Sections A and B of this questionnaire.
  2. What time period(s) were you furloughed or worked without pay?
    Provide the beginning and ending date(s).
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  3. What is the name of your federal agency or department?
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  4. Prior to the shutdown, what was your employment status? (Check either Part Time of Full Time.)
  5. Hourly Rate of Pay:
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    Average Hours per Week:
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  6. Have you received or will you receive backpay for the time you were furloughed or working without pay during the federal shutdown?
  7. You must report your gross wages (before taxes and deductions) for each week listed below.
    For information on how to report your gross wages, visit edd.ca.gov/unemployment/How_to_Report_Work_or_Earnings.htm
    Week
    Beginning Date    		 Week
    Ending Date    		 Gross
    Wages
    MM/DD/YYYY MM/DD/YYYY Blank Line_____________
    MM/DD/YYYY MM/DD/YYYY Blank Line_____________
    MM/DD/YYYY MM/DD/YYYY Blank Line_____________
    Week
    Beginning Date    		 Week
    Ending Date    		 Gross
    Wages
    MM/DD/YYYY MM/DD/YYYY Blank Line_____________
    MM/DD/YYYY MM/DD/YYYY Blank Line_____________
    MM/DD/YYYY MM/DD/YYYY Blank Line_____________

Section B: Sign, date, and return this notice and the Personal Financial Statement in the enclosed envelope, no later than MM/DD/YYYY

I declare under penalty of perjury that the information I am providing is true and correct. I understand that providing false information or withholding information to receive UI benefits can be a felony. Penalties may include fines, a loss of benefits, and/or criminal prosecution.

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Printed Name
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Signature
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Date

DE 1447FED (3-19) (INTRANET)