First Name * Last Name * Residential Street Address * Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number * Your Email * Do you have an EDD Customer Account Number (CAN)? - Select -YesNo CAN #(Make sure to include your CAN number provided by EDD) Date of Birth * Date case first filed * Last day of work * Date of last payment * Describe the Issue * Type of Benefit (indicate which benefit you applied for) * Unemployment PUA (Pandemic Unemployment Assistance) PEUC (Pandemic Emergency Unemployment Compensation) FED-ED Extension Not Sure Reason given by EDD for interruption of benefit payments * ID Verification Suspected/Potential Fraud Disqualified Website issue Need to reopen case No benefits left Other or no reason given by EDD Additional for issues with EDD * Payments Pending File a new claim issue Unable to Certify for Benefits Extension Pending Leave this field blank