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How to use or fill out uncashed benefit payment check or unclaimed electronic benefit payment claim form
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Click ‘Get Form’ to open it in the editor.
Begin with the Claimant Information section. Fill in your last name, first name, middle initial, address, Social Security number, city, state, ZIP code, and phone number.
If you are filing on behalf of someone else, complete the Attorney or Representative Information section with their details including relationship to the claimant.
In the Claim Information section, specify the type of payment (Unemployment Insurance, Disability Insurance, or Paid Family Leave) and indicate if your claim is for a stale-dated check.
Provide the exact name on the check and its dollar amount. If you have the original check, indicate this and attach copies of both sides.
Complete any additional questions regarding EDD Debit CardSM activation and notices from Bank of America.
Finally, read the declaration statement carefully before signing and dating the form at the bottom.
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