Form De 945 - Annual Income Report For Disability Insurance Elective Coverage - Employment Development Department, State Of California Page 2

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INFORMATION REGARDING THE ANNUAL INCOME REPORT FOR
DISABILITY INSURANCE ELECTIVE COVERAGE (DE 945)
Sections 708 and 708.5 of the California Unemployment Insurance Code require participants to provide a copy of
their annual income statement of net profit or loss as reported to the Internal Revenue Service (IRS) for the prior
tax year to the Employment Development Department.
If your tax filing period with the IRS is not based on a calendar year (January 1 to December 31), please provide
your tax period ending date and the due date reported with the IRS for filing your taxes. This information will
assist EDD in posting your annual income to the correct period for premium and benefit determination purposes.
Tax Year End Date _____ / _____ / _____
Date Due to IRS _____ / _____ / _____
Please submit this form postmarked by the due date indicated on the top of the first page. Failure to timely submit
this signed form with the requested information without good cause may result in receiving delinquency notices
and potentially impact your future disability insurance benefits.
For assistance in completing this form, please call (916) 654-6288 or the Taxpayer Assistance Center at
(888) 745-3886. For TTY (non-verbal) access, call (800) 547-9565.
Page 2 of 2
DE 945 Rev. 5 (2-11) (INTERNET)
CU

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