EDD AssistanceForm

Select your zip code *

Contact Information

First Name *

Last Name *

Street Address *

City *

Zip Code *

Phone Number *

Email Address *

EDD Information

Date your unemployment claim was filed *

Month

Day

Year

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

CAN # *

Date of Birth *

Month

Day

Year

What EDD program did you apply for? *

What is your issue with EDD? *

Have you certified for ALL weeks pending of benefits? *

How many weeks of benefits are you owed? *

When was the last time you received a correspondence from EDD (via mail, phone, or text) *

Month

Day

Year

Have you contacted another elected official? *

If yes, who have you contacted?

Summary of Issue: *

Leave this field blank