Select your zip code * - Select - 90025 90028 90032 90220 90601 91006 91007 91010 91016 91107 91108 91361 91702 91706 91709 91722 91723 91724 91731 91732 91733 91740 91744 91745 91746 91748 91754 91755 91767 91770 91773 91775 91776 91780 91790 91791 91792 91801 91803 92311 92532 Contact Information First Name * Last Name * Street Address * City * Zip Code * Phone Number * Email Address * EDD Information Do you have an EDD Customer Account Number (CAN)? * - Select -YesNo EDD Customer Account Number * Date of Birth * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Year Date your unemployment claim was filed * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year What EDD program did you apply for? * Unemployment Insurance (UI) Pandemic Unemployment Assistance (PUA) State Disability Insurance (SDI) Paid Family Leave (PFL) workshare What is your issue with EDD? * ID Verification Wage Verification Appeals Unpaid Benefits Pandemic Unemployment Assistance Payments Pending File a new claim issue Unable to Certify for Benefits Extension Pending 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) * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year20222023202420252026 Year Have you contacted another elected offical? * Yes No If yes, who have you contacted? Summary of Issue: * Leave this field blank Submit
