Po box 5007 buena park ca-2026

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The document is an authorization form allowing the Employment Development Department (EDD) to release Unemployment Insurance (UI) information for a retired annuitant, in compliance with California Government Code section 21224. It includes sections for personal details, signatures, and a confidentiality notice regarding the sensitive nature of the information.

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Click ‘Get Form’ to open the Authorization for Release of Unemployment Insurance Records in the editor.
Begin by entering your name in the designated field labeled 'PRINT YOUR NAME'. This is essential for identifying yourself in the authorization.
Fill in the 'NAME AND TITLE' section with the appropriate details of the appointing entity. Ensure accuracy as this information is crucial for processing your request.
Complete the 'STATE AGENCY MAILING ADDRESS' and 'CITY, STATE, AND ZIP CODE' fields to provide a clear destination for your request.
Sign and date the form in the 'RETIRED ANNUITANT SIGNATURE' section. Remember, this authorization remains valid for 12 months from your signature date.
If applicable, indicate whether UI benefits were paid to you in the last 12 months by selecting 'YES' or 'NO'.

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