Name Email Phone Address City Zip code Do you have an EDD Customer Account Number (CAN)? - Select -YesNo 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) - Select -UnemploymentPUA (Pandemic Unemployment Assistance)PEUC (Pandemic Emergency Unemployment Compensation) Reason given by EDD for interruption of benefit payments - Select -ID VerificationSuspected/Potential FraudDisqualifiedWebsite issueNeed to reopen caseNo benefits leftOther or no reason given by EDD Have you certified for ALL weeks pending of benefits? Yes No Unsure If no, which weeks have you certified for? How many weeks of benefits are you owed? (Please answer as accurately as possible) Leave this field blank