Fillable Printable Appeal Form (De 1000M/T)
Fillable Printable Appeal Form (De 1000M/T)
Appeal Form (De 1000M/T)
EDD Telephone Numbers:
E
NGLISH1-800-300-5616
S
PANISH1-800-326-8937
C
ANTONESE1-800-547-3506
M
ANDARIN1-866-303-0706
V
IETNAMESE1-800-547-2058
T
TY (non-voice)1-800 815-9387
website: www.edd.ca.g ov
APPEAL FORM
If you disagree with the Notice of Determination(s) and/or Determination(s)/Rulings by the EDD, you may appeal the
decision(s) to the California Unemployment Insurance Appeals Board (CUIAB) by completing this form and
explaining whyyou disagree. You must sign the form and return it to the EDD at the office address listed on the
notice that you areappealing. YOU HAVE 30 DAYS FRO M THE MAIL DATE OF THE NOTICE TO FILE A TIMELY
APPEAL. If you appeal after the 30-day pe riod, you must i nclude the reason for the delay. The administrative law
judge (ALJ) will determine whether you had good cause for the delay. If the ALJ determines you did not have good
cause to submit your appeal late, your appeal will be dismissed.
CLAIMANTS: While your appeal is pending, you must conti nue to certify for benefits. If you are found eligible,
you can be paid only for periods for which you have certified and have met all other eligibility requirements.
NOTE: Claimants for Disaster Unemployment Assistance (DUA) have 60 days to file an appeal. Employers appealing
the Notice of Determination or Assessment, DE3807, have 30 days to file an appeal.
SECTION IAPPELLANT INFORMATION
INSTRUCTIONS: The followi ng information must be provided by the Appellant (the claimant or employer who is
appealing a notice), or by the authorized agent or representative of the Appellant. The signature of the Appellant or
agent is required. Please use BLACK INKwhen filli ng out this form.
Claimant Name:Social Security Number:- -
Do you need a translator?YesNoIf yes, what language/dialect ?
Appellant Address:Telephone No.:() -
Street No., Apt. No., or P.O. Box
Fa x No.:() -
CityStateZIP Code
E-mail Address:Cell Phone No.:() -
I authorize the CUIAB to send confidential information regarding my appeal to the e-mail address listed above.
I authorize the CUIAB to send confidential information regarding my appeal by text message or voice mail to the
cell phone number listed above.
Complete this section for employer appeals only
Employer Account Number:Agent Name (if applicable):
Agent Address:
Street No., Apt. No., or P.O. BoxCityStateZIP Code
SECTION IIAPPELLANT STATEMENT
INSTRUCTIONS: Explain the reason foryour appeal and why you disagree with the decision(s). If required, attach
additional pages to this form and write your name and Social Security number on each page.
I disagree with the determination in the notice datedbecause
Signature of
Appellant or Agent:Date:
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EDD �:
1-800-300-5616
1-800-326-8937
1-800-547-3506
1-866-303-0706
1-800-547-2058
TTY (
-)1-800-815-9387
websi te: www.e dd.ca.gov
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