Fillable APPEAL FORM If you disagree with the Notice (California)

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APPEAL FORM If you disagree with the Notice (California)

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DE 1000M/T Rev. 8 (6-15) (INTERNET) - Tagalog version on the other side - CU
Page 1 of 2
EDD 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
TTY (non-voice) 1-800 815-9387
website: www.edd.ca.gov
APPEAL FORM
If you disagree with the Notice of Determination(s) and/or Determination(s)/Rulings by the EDD, you may appeal the
decision(s) to the California Unemployment Insurance Appeals Board (CUIAB) by completing this form and
explaining why you disagree. You must sign the form and return it to the EDD at the office address listed on the
notice that you are appealing. YOU HAVE 30 DAYS FROM THE MAIL DATE OF THE NOTICE TO FILE A TIMELY
APPEAL. If you appeal after the 30-day period, you must include the reason for the delay. The administrative law
judge (ALJ) will determine whether you had good cause for the delay. If the ALJ determines you did not have good
cause to submit your appeal late, your appeal will be dismissed.
CLAIMANTS: While your appeal is pending, you must continue to certify for benefits. If you are found eligible,
you can be paid only for periods for which you have certified and have met all other eligibility requirements.
NOTE: Claimants for Disaster Unemployment Assistance (DUA) have 60 days to file an appeal. Employers appealing
the Notice of Determination or Assessment, DE 3807, have 30 days to file an appeal.
SECTION I APPELLANT INFORMATION
INSTRUCTIONS: The following information must be provided by the Appellant (the claimant or employer who is
appealing a notice), or by the authorized agent or representative of the Appellant. The signature of the Appellant or
agent is required. Please use BLACK INK when filling out this form.
Claimant Name: Social Security Number: - -
Do you need a translator? Yes No If yes, what language/dialect?
Appellant Address: Telephone No.: ( ) -
Street No., Apt. No., or P.O. Box
Fax No.: ( ) -
City State ZIP Code
E-mail Address: Cell Phone No.: ( ) -
I authorize the CUIAB to send confidential information regarding my appeal to the e-mail address listed above.
I authorize the CUIAB to send confidential information regarding my appeal by text message or voice mail to the
cell phone number listed above.
Complete this section for employer appeals only
Employer Account Number: Agent Name (if applicable):
Agent Address:
Street No., Apt. No., or P.O. Box City State ZIP Code
SECTION II APPELLANT STATEMENT
INSTRUCTIONS: Explain the reason for your appeal and why you disagree with the decision(s). If required, attach
additional pages to this form and write your name and Social Security number on each page.
I disagree with the determination in the notice dated because
Signature of
Appellant or Agent: Date:
DE 1000M/T Rev. 8 (6-15) (INTERNET) - English version on the other side - MIC 38/CU
Page 2 of 2
Mga Numero ng Telepono ng EDD:
INGLES 1-800-300-5616
ESPANYOL 1-800-326-8937
CANTONESE 1-800-547-3506
MANDARIN 1-866-303-0706
VIETNAMESE 1-800-547-2058
TTY (hindi sinasalita) 1-800 815-9387
website: www.edd.ca.gov
FORM NG PAG-APELA
Kung hindi ka sumasang-ayon sa Abiso ng (Mga) Kapasyahan at/o (Mga) Kapasyahan/Pagpapasya ng EDD, maaari mong iapela
ang (mga) desisyon sa Kapulungan ng California para sa Mga Pag-apela sa Seguro sa Pagkawala ng Trabaho (California
Unemployment Insurance Appeals Board o CUIAB) sa pamamagitan ng pagkumpleto sa form na ito at pagpapaliwanag kung bakit
hindi ka sumasang-ayon. Dapat mong lagdaan ang form at ibalik ito sa EDD sa address ng tanggapan na nakalista sa abiso na
iyong inaapela. MAYROON KANG 30 ARAW MULA SA PETSA NG PAGPAPADALA NG ABISO UPANG MAGHAIN NG
NAPAPANAHONG APELA. Kung mag-aapela ka pagkalipas ng yugto ng 30 araw, dapat mong isama ang dahilan ng pagkaantala.
Magpapasya ang hukom ng administrative law (ALJ o administrative law judge) kung wasto ang dahilan ng iyong pagkaantala. Kung
matutukoy ng ALJ na hindi wasto ang iyong dahilan ng pagsusumite ng iyong apela nang huli, mapapawalang bisa ang iyong apela.
MGA NAGHAHABOL: Habang nakabinbin ang iyong apela, dapat mong ituloy ang pagbibigay-patunay para sa mga
benepisyo.. Kung mapagpapasyahang karapat-dapat ka, maaari kang mabayaran para lang sa mga yugto kung kailan ka
nagbigay-patunay at kung kailan mo natugunan ang lahat ng iba pang kinakailangan para sa pagiging karapat-dapat.
TANDAAN: Ang mga naghahabol ng Tulong sa Pagkawala ng Trabaho dahil sa Sakuna (Disaster Unemployment Assistance o
DUA) ay may 60 na araw upang maghain ng apela. Ang mga employer na umaapela sa Abiso ng Pagpapasya o Pagtatasa (Notice
of Determination or Assessment), o DE 3807, ay may 30 araw upang maghain ng apela.
SEKSYON I IMPORMASYON NG NAG-AAPELA
MGA TAGUBILIN: Ang sumusunod na impormasyon ay dapat na ibigay ng Nag-aapela (ang nag-aapela o employer na nag-aapela
ng isang abiso), o ng may-karapatang ahente o kinatawan ng Nag-aapela. Kinakailangan ang lagda ng Nag-aapela o ahente.
Mangyaring gumamit ng ITIM NA TINTA kapag pinupunan ang form na ito.
Pangalan ng Naghahabol: Social Security Number: - -
Kailangan mo ba ng translator? Oo Hindi Kung oo, anong wika/dayalekto?
Address ng Nag-aapela: Numero ng Telepono:( ) -
Street No., Apt. No., o P.O. Box
Fax No.: ( ) -
Lungsod Estado ZIP Code
E-mail Address: Cell Phone No.: ( ) -
Pinapahintulutan ko ang CUIAB upang magpadala ng kumpidensyal na impormasyon hinggil sa aking apela sa e‑ mail address
na nakalista sa itaas.
Pinapahintulutan ko ang CUIAB na magpadala ng kumpidensyal na impormasyon hinggil sa aking apela sa pamamagitan ng
text message o voice mail sa numero ng cell phone na nakalista sa itaas.
Kumpletuhin ang seksyong ito para lang sa mga apela ng employer
Employer Account Number: Pangalan ng Ahente (kung naaangkop):
Address ng Ahente: _____________
Street No., Apt. No., o P.O. Box Lungsod Estado ZIP Code
SEKSYON II PAHAYAG NG NAG-AAPELA
MGA TAGUBILIN: Ipaliwanag ang dahilan ng iyong apela at bakit ka hindi sumasang-ayon sa (mga) desisyon. Kung kinakailangan,
maglakip ng mga karagdagang pahina sa form na ito at isulat ang iyong pangalan at Social Security number sa bawat pahina.
Hindi ako sumasang-ayon sa pagpapasya sa abisong may petsang dahil
Lagda ng
Nag-aapela o Ahente: Petsa:
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APPEAL FORM If you disagree with the Notice (California)

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Completed 13 November 2021

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