EDD Intake Form

EDD Assistance Request Form

In order to assist you with your EDD matter we ask you to complete the information on this form.. Make sure to include your 10 digit CAN = Customer Account Number. You can find your CAN on the letter EDD sent you (via U.S. Mail) with the instructions needed to register your on-line account. We cannot escalate your matter without this information. If you cannot locate your CAN, you can still submit your request but there will be a delay until a member of our office staff contacts you for alternative confirmation information. 

Residential Street Address *