EDD Assistance Form

*Important: Before filling out the form below, please use the "Find my Representative" link to make sure you are in the correct district.

Name

Phone

Address

City

Zip code

Do you have an EDD Customer Account Number (CAN)?

CAN #(Make sure to include your CAN number provided by EDD)

Date of Birth

Date case first filed

Last day of work

Date of last payment

Describe the Issue

Type of Benefit (indicate which benefit you applied for)

Reason given by EDD for interruption of benefit payments

Have you certified for ALL weeks pending of benefits?

Yes

Unsure

If no, which weeks have you certified for?

How many weeks of benefits are you owed? (Please answer as accurately as possible)

Office Information