EDD Assistance

Please watch this EDD video before you fill out your EDD Assistance form. Thank You.

Contact Information
Name
Address
What is your issue?
Have you certified for ALL weeks pending of benefits?
Have you contacted another elected official?

REQUEST FOR ASSISTANCE AND AUTHORIZATION FOR RELEASE OF INFORMATION

Please carefully read the following:

By completing this form, I am requesting the Office of Assemblymember Salas (the “Assemblymember”) to assist me in working with the Employment Development Department (EDD) on my claim. I acknowledge that this may require the release of information contained in my records the dissemination of which may be prohibited by law. Therefore, I hereby authorize EDD and the Assemblymember to share all relevant portions of my records with each other, and to discuss matters relating to those records and my claim, until my claim is resolved.

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