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Fillable Printable Notice Of Request For School Or Training Information (De 4365T)

Fillable Printable Notice Of Request For School Or Training Information (De 4365T)

Notice Of Request For School Or Training Information (De 4365T)

Notice Of Request For School Or Training Information (De 4365T)

NOTICE OF REQUEST FOR SCHOOL OR TRAINING INFORMATION
You are recei ving this
Notice of Request for School or Training Information
, DE 4365T, because you reported to
the Employment Development Department (EDD) t hat you began attending school or tr aining and that you are
unavailable for work and/ or not seeking work. Attendance in school or traini ng may affect your eligi b ility to receive
unempl oyment insurance (UI ) benefi ts unless your school or training plan is approved by the EDD under the California
Training Benefits (CTB) program or t he EDD determ ines you are actively seeking work and remain available to accept
work while attending school or traini ng. Informat ion about the CTB program is provided on the enclosed
California
Training Benefits (CTB) Program Fact Sheet
, DE 8714U, and on page 2 of this notice.
In order to determ ine your eligibility for the CTB program and UI benefits, the enclosed
California Training Benefits (CTB)
Application and School or Training Quest ionnaire
, DE 4365TQ, and the
Training Provider Questionnaire
, DE 4365TP,
must be properly completed, signed, and returned withi n ten (10) calendar days
of the mail date of this notice. The
Training Provider Questionnaire,
DE 4365TP, must be completed by an authorized representat ive from your
school or training pr ovider, t raining program, or tr ade union or association. Refer to the back of this noti ce for
instr uctions on returning the compl eted questionnair es by fax or by mail.
Your UI benefits cannot be paid until the EDD determines your eligibility for the CTB program or approves your
school or training attendance while you collect UI benefits based on the informa tion you provide. FAILURE TO
PROVIDE THE REQUESTED INFORMATION OR RETURN THE COMPLETED AND SIGNED QUESTIONNAIRES
WITHIN 10 CALENDAR DAYS MAY RESULT IN THE DENIAL OF YOUR UI BENEFITS.
IMPORTANT INFORMATION
If you are not cur rently attendi ng school or training and you are not in a recess or break period,youmust
complete Sections B and C of the
California Tr aining Benefits (CTB) Application and School or Training Questionnaire
,
DE 4365TQ, sign and return the form within 10 calendar days of the mail date of thi s notice or a decision on your UI
eligibility will be made based on available information.
If you are i n a traini ng program authori zed by the Workf orce Innovation and Opportunity Act (WIOA) or the Trade
Adjustment Assi stance (TAA) program, the EDD m ust verify your enrollment and participat ion in training wi th your
authorized program repres entative. You may contact your WIOA or TAA program representative to have a
Training
Enrollment Verif ication
form submitted on y our behalf thr ough a separate, expedited process for CTB approval. Otherwise
you must compl ete the enclosed questionnai re and have your authorized program representative compl ete the
Training
Provider Questionnaire
, DE 4365TP, and return the completed questi onnaires within 10 cal endar days.
EDD PHONE NUMBERS:
English 1-800-300-5616
Spanish 1-800-326-8937
Mandarin 1-866-303-0706
Vietnamese 1-800-547-2058
Cantonese 1-800-547-3506
TTY (nonvoice)1-800-815-9387
Employment Development Depar tment
ATTN: CTB Unit
P.O. Box 599000
Elk Grove, CA 95759-9906
Mail Date:
Benefit Year Begins (BYB):
DE 4365T Rev. 2 (10-15) (INTERNET)
Page 1 o f 2 CU
Form Tracking:
Claimant Name
Claimant Mailing Address
Claimant City, State, Zip
SAMPLE
DE 4365T Rev. 2 (10-15) (INTERNET)
Page 2 o f 2
RIGHTS AND RESPONSIBILITIES
The EDD will use the information provi ded on the returned questionnaires and any attached documents t o determine your eligibility
for the CTB program and your continued eligibility to receive UI benefits while you attend school or training. Ifyoufailtoreturnthe
completed quest ionnaires within 10 calendar days, your eligi bility will be determined based on available information and
your UI benefits may be denied. I f the returned questionnaires are i ncomplete or illegible, the EDD may return the questionnaires to
you to provide the missing or illegible inform ation, and your UI benefits will continue to be delayed until the information is provided.
You have the right to cont act the EDD and request a t elephone eligib ility interview if you need m ore tim e to gather information,
contact wi t nesses, or obtain advi ce from a representative. Please be advised that scheduling a telephone interview instead of
returning t he completed questionnair e may result i n an additional delay in your UI benefit payments. No UI benefits can be paid until
the interview is completed and your eligibility is determined.
CTB PROGRAM INFORMATION
If you ar e eligible for t he CTB program, you are not required to be available for immediate employment, to actively seek work, or to
accept an offer of suit able work while at tending an EDD approved peri od of training. Dependi ng on the ci rcumstances of your
individual cl aim, you may potentially be eli gible for a Trai ning Extension (TE) claim after your r egular benefits are exhausted if you
are still attending approved traini ng and you are not receivi ng federal extended benefits. Your school or training can only be approved
for t he CTB program if you are authorized by a designat ed state or federal program, i n a traini ng program with a provider on
California’s Eli gible Training Provider List (ETPL) , a journey level union member in industry related training, certain public school
teachers attending an approved program for an additional credential i n Math, Science, or Special Education, or enr olled in a program
that meets all the eligibility requirem ents of Chapter 5, Arti cle 1. 5 of the Californi a Unemployment Insurance Code. Ref er to the
enclosed
CTB Fact Sheet
, DE 8714U, for detailed CTB and TE eligi b ility criteria.
The CTB program does not
guarantee that UI benefits wil l be available for the entire period of your training or at the same
weekly benefit amount . Your eligibility for UI benefits ends when you fail to meet all UI eligibility criteria or when available UI
benefits run out, regardless of how long you are approved to attend school or training.
ELIGIBILITY NOTICES
If you are eligible for the CTB program , you will be m ailed a
Notice of Determinat ion
, DE 1080, and any pending UI benefit payments
will be issued, as long as you are otherwise eligible to receive UI. Your initial eligibility for a TE claim is also included in the
Notice of
Determination
along wit h your rights and r esponsibilities for participation in the CTB program .
If you are not eligible for the CTB program you will be m ailed a
Notice of Determinat ion
informing you of the reason for the decision
and your appeal right s. However, you may still be issued any pending UI benefit payments,
if you are otherwise eligible to
receive UI benefits and
you have pr ovided suffi cient inf ormation to show t hat you ar e available for work, actively looking
for work and willing to drop or modify school to accept work.
If you ar e not eligible f or the CTB program and the EDD determines you are not available for work, you will receive a separate
Notice
of Determination
informing you of the reason benefits ar e denied and your appeal rights.
FALSE STATEMENTS AND O VERPAYMENTS
If you willfully give false inform ation or withhold inf ormation about school or training att endance in order to claim UI benefi ts, you may
be subject t o a false statement penalty that denies your benefits from two (2) to t wenty-three (23) weeks. You may be r equired to
repay any UI benefits whi ch y ou were not entitl ed to receive.
RETURN INSTRUCTIONS
You must ret urn both the compl ete and signed three (3) page
California Training Benefits (CTB) Application and Schoo l or
Training Questionnaire
, DE 4365TQ, and the two (2) page
Training Provider Questionnaire
, DE 4365TP, within 10 calendar
days either by fax at 1-855- 873-4359 or by mail in t he enclosed envelope to t he Employment Development Department,
P.O . Box 599000, Elk G rove, CA 95759. Do not return the cover letter, or the enclosed
Training Provider Letter
, DE 3100D, to the
EDD. Attach any additional documents you wish to be consi dered and include your name and the last four digits of your social
security number on each page. If you ar e returning the questionnaires by fax, send all documents and attachments in one
continuous fax t ransmission.
The EDD fax number and return envelope are to only be used for submitting the quest ionnaires and related att a chments.
All document s are processed automatically and any documents submitted ot her than the questionnaire and related
attachments will be destroyed.
Please allow the EDD 10 days af ter t he date you return this form by mail or fax before you inqui re about your eligibility results in
order to all ow t he EDD time to process your claim.
CONTACTING EDD
If you have any questions about this form, the CTB program, or if you need to make any cor r ections to the information you have
supplied, you can contact the EDD by going online to the EDD website at www.edd.ca.gov and selecting the “Cont act EDD” tab or by
calling one of the toll-free telephone numbers listed at the top of page 1 of thi s notice.
SAMPLE
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