Form De 1000m - Employment Development Department Appeal
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1
2EDD Telephone Numbers:
English
1-800-300-5616
Spanish
1-800-326-8937
Cantonese
1-800-547-3506
Mandarin
1-866-303-0706
Vietnamese
1-800-547-2058
Self-Service
1-866-333-4606
TTY (non voice)
1-800 815-9387
EMPLOYMENT DEVELOPMENT DEPARTMENT APPEAL FORM
If you want to appeal a Department determination, please explain why you disagree and return this form to the Department using the
office address listed on the enclosed notice. You have 20 days from the date of the notice to file an appeal. The 20-day period may be
extended for good cause. Reasons for filing an appeal after 20 days must be explained and failure to do so may result in closure of your case.
Please note that claimants for Disaster Unemployment Assistance have 60 days to file an appeal. Employers who are appealing the
Department’s DE 3807 Notice of Determination or Assessment have 30 days to file an appeal.
I disagree with the Department’s decision dated
because:
(Attach an additional sheet if more space is required)
CLAIMANTS: While your appeal is pending, you must continue to file a continued claim form for the period that you want to claim
benefits. If you are found eligible, you can be paid only for periods for which you have filed continued claim forms and have met
all other eligibility requirements. For more information on appeal hearings, visit
The following information must be provided by the party filing the appeal (Appellant) or an authorized
agent of the party filing the appeal. Signature of the appellant or agent is required.
Do you need a translator?
Yes
No If yes, please give language and dialect:
Appellant Name:
Appellant Telephone No.: (
)
-
Appellant Fax No.: (
)
-
Appellant Cell Phone No.: (
)
-
Appellant E-mail Address:
Do you give permission for the California Unemployment Insurance Appeals Board to send confidential information regarding your
appeal to this e-mail address?
Yes
No
Do you give permission for the California Unemployment Insurance Appeals Board to send confidential information regarding your appeal to
your cell phone number listed above by text message or voice mail so that information may be received sooner?
Yes
No
Appellant Mailing Address:
Street No., Apt. No., or P.O. Box
City
State
ZIP Code
Claimant Name:
Employer Account Number:
-
-
(For employer appeal only)
Claimant Social Security Number:
-
-
Agent Name
(If applicable):
Mailing Address:
Street No., Apt. No., or P.O. Box
City
State
ZIP Code
Signature
Date:
Appellant or Agent:
- Versión en español en el dorso -
DE 1000M Rev. 5 (11-10) (INTERNET)
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