DE 1326T (11-14) (INTERNET) Page 1 of 2 CU
Employment Development Department
P.O. Box 2530
Rancho Cordova, CA 95741-2530
Toll-Free Phone Number: 1-866-401-2849
REQUEST FOR IDENTITY INFORMATION REGARDING AN OVERPAYMENT DEBT
Mail Date:
You contacted the Employment Development Department (EDD) about a California Unemployment Insurance (UI)
overpayment debt that you state does not belong to you because you did not file a UI claim effective or you did
not receive the overpaid UI benefits. In order for the EDD to determine who filed the claim and was overpaid UI benefits, you
must mail copies of the identity verification documents requested on page 2 of this notice along with this completed form in
the enclosed envelope within 10 calendar days.
The overpayment debt will remain on your records with the EDD unless you send this completed form and as many
documents as possible that prove that you did not receive UI benefits. Until the debt is paid in full, collection efforts will
continue that may include offsets of future UI and Disability Insurance (DI) benefit payments, wage garnishment, and referral
to federal and state agencies for collection of the amount owed from future income tax refunds, State of California lottery
winnings, and unclaimed property funds.
PLEASE PROVIDE THE FOLLOWING IDENTITY INFORMATION:
The Social Security number that was used to file this claim is:
This Social Security number was issued to me by the Social Security Administration.
This Social Security number was not issued to me by the Social Security Administration.
Other Social Security numbers you have used:
Full name (as it appears on your Social Security Card):
First Middle Last
Other names you have used:
YOU MUST CHECK ALL BOXES BELOW THAT APPLY TO YOU:
I did not file this claim for UI benefits in California.
I have never lived in California.
I have never worked in California.
I filed a claim for UI benefits in California on but I never received any benefits.
I filed a claim for UI benefits in California on and I received benefits until .
I filed this claim for UI benefits and I am currently claiming benefits.
PLEASE PRINT ALL EMPLOYER NAMES YOU WORKED FOR DURING THE YEAR(S) :
If you don’t have enough space, please use an additional page.
Employer name: Employer name:
Employer name: Employer name:
Employer name: Employer name:
PLEASE PRINT ALL ADDRESSES THAT YOU USED DURING THE YEAR(S) :
Please begin with your most recent mailing or residential address (including the full street address, city, state, and ZIP code).
If you don’t have enough space, please use an additional page.
Period of time: Address:
Period of time: Address:
Period of time: Address:
Period of time: Address:
SIGN AND RETURN THIS DOCUMENT WITHIN 10 CALENDAR DAYS FROM THE MAIL DATE OF THIS FORM.
Use the envelope provided, enclose all requested identity verification documents, and include your complete Social Security
number on each document you submit (Refer to page 2 for a description of identity documents you can provide).
By signing below you agree to the following statement: I understand the law provides penalties if I make false statements
or withhold facts to obtain benefits; I declare under penalty of perjury that the information I am providing is true and correct.
Signature Date Phone number
SAMPLE
Claimant Name
Claimant Mailing Address
Claimant City, State, ZIP
MM/DD/YYYY
MM/DD/YYYY
DE 1326T (11-14) (INTERNET) Page 2 of 2
ACCEPTABLE DOCUMENTS FOR IDENTITY VERIFICATION
You must send a copy of ONE document from the “Photo Identification” column AND copies of as many of the requested
documents as you can provide from the “Other Identity Documents “column below. The overpayment debt will remain on
your records with the EDD unless you send sufficient documents that prove that you did not receive the UI benefits.
All copies should be printed on 8½” x 11” paper and you must write your Social Security number on each page.
PHOTO IDENTIFICATION
Provide a clear and readable copy of ONE
of the following documents.
OTHER IDENTITY DOCUMENTS
Provide a clear and readable copy of ALL of the following documents
with the check box marked.
Driver license or ID card issued by a
state, local, or federal agency that
contains your name, your date of birth,
and your photograph.
Official document issued to you by a
state, local, or federal agency that
contains your name, your date of birth,
and your photograph.
U.S. Passport or U.S. Passport Card
that contains your name, your date of
birth, and your photograph
U.S. Military card that contains your
name, your date of birth, and your
photograph (front and back)
Military dependent’s ID card that
contains your name, your date of birth,
and your photograph (front and back)
Alien Registration or Permanent
Resident Card (Form I-551) issued by
the U.S. Citizenship and Immigration
Services that contains your name, your
date of birth, and your photograph
Certificate of Naturalization
(Form N-550)
Employment Authorization Document
(Form I-766) issued by the U.S.
Citizenship and Immigration Services
that contains your name, your date of
birth, and your photograph.
Employment Data
A copy of at least one W-2 issued to you for the year(s)
A copy of at least one check stub or payment statement issued to you
by your employer during the year(s) .
The check stub or payment statement must be pre-printed with all of the
following:
Your first name or initial and your last name, and
Your Social Security number (or at least the last four digits) or your
employee identification number, and
The name of your employer, and
The date or pay period the check stub or pay statement was issued.
Address Verification
A copy of an unaltered utility bill (e.g., electricity, gas, garbage, water,
or sewer), cable TV bill, phone bill, bank statement, or mortgage
statement that shows your name and residence address issue to you for
the year(s) .
If you do not have a residence address, but you have a P.O. Box or a
Private Mail Box, you must provide registration verification showing that
you are the renter or authorized user of the box.
Social Security number Verification
A complete copy of your annual Social Security Statement (pages 1,
2, and 3) issued by the Social Security Administration.
Do not send an original or copy of your Social Security card. It will not
satisfy this requirement.
Date of Birth Verification
A copy of an official birth certificate issued by a local, state, or federal
agency, or a foreign government, or other official certification of your
birth.
A birth certificate marked “Information, not a valid document to establish
identity” is not acceptable verification.
Marriage Certificate (if applicable)
A copy of an official marriage certificate issued by a local, state, or
federal agency, or a foreign government, or other official certification of
your marriage.
Proof of Identity Theft
A copy of all reports and correspondence related to your reported
identity theft, including:
Police reports.
Credit agency reports.
California Franchise Tax Board (FTB) reports.
Internal Revenue Service (IRS) reports.
Social Security Administration reports.
If additional documentation is required, the EDD will contact you.
Employment Development Department
P.O. Box 2530, Rancho Cordova, CA 95741-2530 1-866-401-2849
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