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EDD Assistance
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Contact Information
First Name
*
Last Name
*
Street Address
*
City
*
Zip Code
*
Phone Number
*
Email Address
*
EDD Information
Date your unemployment claim was filed
*
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Day
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What EDD program did you apply for?
*
Unemployment Insurance (UI)
Pandemic Unemployment Assistance (PUA)
State Disability Insurance (SDI)
Paid Family Leave (PFL)
What is your issue with EDD?
*
ID Verification
Wage Verification
Appeals
Unpaid Benefits
Pandemic Unemployment Assistance
Other
If "other", please describe your issue in a few words:
Have you certified for ALL weeks pending of benefits?
*
Yes
No
How many weeks of benefits are you owed? (Please answer as accurately as possible)
*
When was the last time you received a correspondence from EDD (via mail, phone, or text)
*
Month
Jan
Feb
Mar
Apr
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Aug
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Dec
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Day
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2019
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Have you contacted another elected offical?
*
Yes
No
If yes, who have you contacted?
Summary of Issue:
*
Disclaimer:
*
Please do not send any personal identifiable information through this form that is not specifically requested. If we need additional information, such as your EDD number, we will contact you to request that information.
I Agree
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