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NORTH LOS ANGELES DI OFFICE
P0 BOX 10402
vAN NUYS, CA 91410-0402
Telephone No. 8OO-48O-3287
Your Social Security Nun5er:
575- 13-27 19
l,l,,,,l,l,ll,,,,l,l,ll',"'lll,,'ll,l,,,l"l"ll,,,ll'1,,1'
DANIEL K KAU$IE
933 BEGO}IIA
AVE
cosrA ttEsA, cA 92626-179\
Employment
Development
D e part me nt
StatEof
California
--t{oTffi
This notice does not establish
your right to benefits.
State Disability
Insurance
or Paid Family Leave
benefits
are paid to you only when you meet all the
conditions
ot eligibility.
O1429
ALL CHECKS,
IF DUE. ARE MAILED SEPARATELY.
-\EDD
MITICE 0F COIiIPUTATI0N
o
Your maxilum Benefit amount
Vour daily
Benefit amount
Your claim effective date
The nailing date of this Notice
You should:
. Verify that your Social Security
. Read the enciosed Explanation oi
24,492.OO
471.OO <-------
67.28
10/13/08
PRoGRAII R
10/so/08
is
is
is
is
is
$
$
$
tturben (SSN) is correct.
Notice of Conputation, DE 429DL
cu-PAo64
.FINAL
PAGE O 1
Employment
Development
Department
California
Date: Jl-lne
l.b
2009
Explanation of Benefit Payment Record
Daniel K Kauwe
933 Begonla Avenue
CosLa Mesa, CA 92626"1'794
In response
to your request
for payment
information,
see the attached
copy of the computer
record of your
Disabitity
Insurince
(Di) or Paid Family Leave (PFL) claim payments.
To help you better understand
this
computer
record,
the following
explanation
is provided.
The top portion
of the record
includes
the following
information:
NAME: Self-explanatory
CED: Beginning date of the claim
SSN: Social Security Number
DBA: Dailv Benefit Amount
Adjustment payment
Eligibility
undetermined
Disqualification
Erroneous period paid
Benefit reduction
Lost check replaced
Overpayment
Payment
Qualification
R: Disqualiflcationreversed
T: Payment
in autopay
V: Payment
to voluntary
Plan
W: Waiting period
WBA: Weekly Benefit Amount
MBA: Maximum Benefit Amount
BAL: Balance remaining
in this account
PD DAYS: Number of days paid
DAYS DISQ: Number of days disqualified
AMT pD: Amount of benefits paid
DURC: Estimated end of disability,
need for family care, or bonding benefits
The second section of the record, which begins with "ACT," will show what action has been taken on the claim.
The first column, under "ACT," gives the action code:
A:
B:
D:
E:
L:
N:
o:
P:
Q:
Additional
information
about the action taken is shown to the right of the action code:
BGN DT:
END DT:
NUM DYS:
AMT:
ISS DT:
STS:
The beginning date of the action.
The ending date of the action. When "999999' is shown as the ending date, it means an
undetermined
future date, or "until eligible
Number of days included
in the action.
Amount of the check, or the amount of the benefit reduction.
The date the check was issued, or the date the action was taken.
08 - forged
11 - expired
Check status:
01 - not cashed
02 - cashed
06 - lost or stolen
07 - cancelled
lf you have any questions after reading
this form, call 1-800-480-3287
for Dl claims and 1-877-238-4373
for PFL
claims. TTY access (for deaf and hearing-impaired
persons onlv) is available at 1-800-563-2441
for Dl and
1-800-445-1
31 2 for PFL.
lf you need information
regarding an Unemployment
Insurance claim, please call: 1-800-300-5616.
DE 2599 Rev. 6 (2-08) (INTRANET)
Page 1 of 2
-^\
Employment
Development
Department
EDD
StaTFof
California
Fecha: June 16. 2009
Explicacion del R6cord de Pagos de Beneficios
Daniel K Kauwe
933 Begonia Avenue
Costa Mesa. CA 92626-1,794
En respuesta su peticion
de informaci6n
de pagos, por favor vea la copia adjunta del documento
computarizado
detallando
ls pagos en su solicitud el Seguro de Incapacidad
(Dl) o del Permiso Familiar
Pagado
(PFL). Para
asistirle
a comprender
mejor este documento,
le proporcionamos
la siguiente xplicaci6n.
La parte de arriba del documento
incluye
la siguiente
informaci6n:
SSN: N0mero de Seguro Social
NAME: Nombre
GED: Fecha de Vigencia de la Solicitud
DBA: Cantidad de Beneficios Diarios WBA: Cantidad Semanal de Beneficios MBA: Cantidad Mdxima de Beneficios
BAL: Balance de la Cuenta
PD DAYS: N0mero de Dias Pagados DAYS DISQ: N[mero de D[as sin Derecho a
Beneficios
AMT PD: Cantidad de Beneficios DURC: Fecha Aproximada de Terminaci6n
de su Incapacidad,
de la necesidad de
Pagados
cuido o beneficios para entablar lazos afectivos
La segunda parte del documento que comienza con las letras "ACT' indica las disposiciones que se han tomado
en la solicitud. La primer columna, bajo "ACT" indica el c6digo de la disposici6n tomada:
R:
T:
V:
W:
N:
o:
P:
Q:
A:
B:
Adjuste de Pago
El Derecho a Beneficios
no ha sido Determinado
D: Derecho a Beneficios Negado
E: Periodo de Pago Err6neo
L: Reducci6n de Beneficios
Cheque Perdido Reemplazado
Pago Indebido
Pago
Requisitos para Tener
Derecho a Beneficios
La Decisi6n de no pagarle ha sido Anulada
Sistema de Pago AutomStico
Pago a un Plan Voluntario
Periodo de Espera Reglamentaria
Otras disposiciones
tomadas en la solicitud son indicadas a la derecha del c6digo de la disposicion
tomada:
BGN DT: La fecha del comienzo de la disposici6n
tomada.
END DT: La fecha en que se termina la disposici6n
tomada. Cuando se indica'999999'alfinal de la fecha
significa una fecha indeterminada
futura o hasta que tenga "derecho a beneficios."
NUM DYS: N0mero de dias incluidos en la disposici6n
tomada.
AMT:
Cantidad del cheque, o la cantidad deducida de los beneficios.
ISS DT:
La fecha de emisi6n del cheque, o la fecha en que la disposici6n
fue tomada.
STS:
Actividad del Cheque: 01 - No ha sido Cobrado
06 - Perdido o Robado 0B - Falsificado
02 - Cobrado
07 - Cancelado
11 - Expirado
Si Ud. tiene alguna pregunta despu6s de leer este formulario,
llame al 1-866-658-8846
para solicitudes de Dl y
al1-877-379-3819
para solicitudes de PFL. El acceso al sistema TTY (para personas con impedimentos
de
sordera o audici6n solamente) esta disponible al 1-800-563-2441
para solicitudes de Dl y al 1-800-445-1
312 para
solicitudes
de PFL.
Sidesea informaci6n
acerca de su solicitud delSeguro de Desempleo,
llame al 1-800-300-5616.
DE 2599 Rev. 6 (2-08)
(INTRANET)
Page 2 ot 2
Mrc62/CU
Page: 1 Document Name: unt.it.led
PAYMENT HTSTORY INQUIRY
SSN: 575 13 271,9
NAME: DAIilIEL
K KAUWE
CED: 10 13 08
DBA: 67.28 WBA: 47t MBA: 24492 RWBA:
0.00 BAL:
8478.00 OVPMT: -
PD DAYS: 00238 DAYS DISQ: 00000 AyIT PD: 16014.00
DURC: 12 29 09 A
CERT TO DT: 00 00 00 STAT:
AUTH CRITCL CMT: N ATP: Y
SURG DT: 00 00 00 HOSP DT: 00 00 00 CLM STAT: A SUSP EX: Y FLAG EX: N
STATUS:
EXP DT:
ISS DT STS
ENCLOSURES
DISO3O6
NEXT
BGN
ACT DT
s 061_509
0 060109
r 051809
P 050409
P 042209
P 040809
P 032509
P 031109
r 0311_09
P 022509
PAGE 1 OF NN
D DEAN
END
DT
06L7 09
06r_409
U)JIUY
051709
050309
042109
0407 09
032409
032409
031_009
NUM REASON/
DYS CHK-NUM
014
014
A1
A
UJ-+
0!2
01.4
01_4
0r4
014
0r4
no
nq
oq
09
no
09
09
09
09
csc
ATP
15068270
L499 8 09r_
l.4827349
t4571903
r439421-0
1-42L597"7
0
r-3936483
9 42 .00
9 42 .00
942.00
807 . 43
942 .00
942 . Q0
942 .00
942.00
942.00
06 1s
06 02
uf
z6
05 16
05 01_
04 2L
04 09
Q4 08
03 24
02
vz
02
02
v4
v4
02 00A
2587
00A
00A
00a
00a
OPER ID
223P9493
21,8D577 4
21,8D577
4
21,8D577 4
2r8D02L6
21-8D577
4
2r8D6t98
2t8D0497
2L8D0497
2L8D0594
Date: 6/l-6/2009 Time 9:24:23 AM
Page: 1 Document. Name: untitled
Drs03 06
NEXT
PAYMENT HISTORY INQU]RY
OVERFLOW
K KAUWE
TSS DT
03 05 09
02 20 09
02 0s 09
01 26 09
01 27 09
0l_ 25 09
01_ 09 09
t2 27 08
t2 !2 08
12 02 08
11 74 08
r_0 31_ 08
1_0 30 08
PAGE 02 OF NN
D DEA}J
CED: 10 13 08
SSN: 57 5 13 2719
NAME : DAItrIEL
BGN
END NUM
ACT DT
DT
DYS
P 02t1,09 022409 01-4
P 0201-09 021009 010
P 01_2609 013109 006
F 012609 01,2609 001
T 0r-0809 01_2509 01-8
r 010809 012509 01-8
r L22508 010709 014
T 1,21108 L22408 01"4
r 1,12708 121008 0t4
r 111_308 1,12608 014
T 103008 ltt208 0l.4
P 102008 1_02908 010
w 101308 101_908 007
r 000000 000000 001
REASON/
CHK_NUM
1_3
6 65131
1347163s
L3252L57
l.3084726
v
1283 471.6
1262567 9
1,2400036
L220t27 0
1-l_9
53-343
11,7 3 4887
A}.{T
942.00
672.86
403 .71,
0.00
r2LL.L4
LztL.t4
942.00
942.00
942.00
942 .00
942.00
672.86
0.00
ENCI,OSURES
OPER ID
2I8D51'.| 4
218D577 4
21_8D2806
2r8D577 4
218D577 4
2t8D577 4
2r8D7 630
218D7630
218D7630
2L8D7 630
21-8D7
63 0
2L8D7 630
STS
02
vz
02
vz
02
02
02
UZ
02
UZ
00A
00A
00A
2595
00A
2593
2587
2LBD7 630
ATP
0.00 01- 26 09
2L8D5774
_ _
10 30 08 _ 2503
Date: 6/L6/2009 Time z 9:24:26 ANI
P0 BOX 10402
vAN NUYS, CA 91410-0402
Telephone No. 8OO-48O-3287
Your Social Security Nun5er:
575- 13-27 19
l,l,,,,l,l,ll,,,,l,l,ll',"'lll,,'ll,l,,,l"l"ll,,,ll'1,,1'
DANIEL K KAU$IE
933 BEGO}IIA
AVE
cosrA ttEsA, cA 92626-179\
Employment
Development
D e part me nt
StatEof
California
--t{oTffi
This notice does not establish
your right to benefits.
State Disability
Insurance
or Paid Family Leave
benefits
are paid to you only when you meet all the
conditions
ot eligibility.
O1429
ALL CHECKS,
IF DUE. ARE MAILED SEPARATELY.
-\EDD
MITICE 0F COIiIPUTATI0N
o
Your maxilum Benefit amount
Vour daily
Benefit amount
Your claim effective date
The nailing date of this Notice
You should:
. Verify that your Social Security
. Read the enciosed Explanation oi
24,492.OO
471.OO <-------
67.28
10/13/08
PRoGRAII R
10/so/08
is
is
is
is
is
$
$
$
tturben (SSN) is correct.
Notice of Conputation, DE 429DL
cu-PAo64
.FINAL
PAGE O 1
Employment
Development
Department
California
Date: Jl-lne
l.b
2009
Explanation of Benefit Payment Record
Daniel K Kauwe
933 Begonla Avenue
CosLa Mesa, CA 92626"1'794
In response
to your request
for payment
information,
see the attached
copy of the computer
record of your
Disabitity
Insurince
(Di) or Paid Family Leave (PFL) claim payments.
To help you better understand
this
computer
record,
the following
explanation
is provided.
The top portion
of the record
includes
the following
information:
NAME: Self-explanatory
CED: Beginning date of the claim
SSN: Social Security Number
DBA: Dailv Benefit Amount
Adjustment payment
Eligibility
undetermined
Disqualification
Erroneous period paid
Benefit reduction
Lost check replaced
Overpayment
Payment
Qualification
R: Disqualiflcationreversed
T: Payment
in autopay
V: Payment
to voluntary
Plan
W: Waiting period
WBA: Weekly Benefit Amount
MBA: Maximum Benefit Amount
BAL: Balance remaining
in this account
PD DAYS: Number of days paid
DAYS DISQ: Number of days disqualified
AMT pD: Amount of benefits paid
DURC: Estimated end of disability,
need for family care, or bonding benefits
The second section of the record, which begins with "ACT," will show what action has been taken on the claim.
The first column, under "ACT," gives the action code:
A:
B:
D:
E:
L:
N:
o:
P:
Q:
Additional
information
about the action taken is shown to the right of the action code:
BGN DT:
END DT:
NUM DYS:
AMT:
ISS DT:
STS:
The beginning date of the action.
The ending date of the action. When "999999' is shown as the ending date, it means an
undetermined
future date, or "until eligible
Number of days included
in the action.
Amount of the check, or the amount of the benefit reduction.
The date the check was issued, or the date the action was taken.
08 - forged
11 - expired
Check status:
01 - not cashed
02 - cashed
06 - lost or stolen
07 - cancelled
lf you have any questions after reading
this form, call 1-800-480-3287
for Dl claims and 1-877-238-4373
for PFL
claims. TTY access (for deaf and hearing-impaired
persons onlv) is available at 1-800-563-2441
for Dl and
1-800-445-1
31 2 for PFL.
lf you need information
regarding an Unemployment
Insurance claim, please call: 1-800-300-5616.
DE 2599 Rev. 6 (2-08) (INTRANET)
Page 1 of 2
-^\
Employment
Development
Department
EDD
StaTFof
California
Fecha: June 16. 2009
Explicacion del R6cord de Pagos de Beneficios
Daniel K Kauwe
933 Begonia Avenue
Costa Mesa. CA 92626-1,794
En respuesta su peticion
de informaci6n
de pagos, por favor vea la copia adjunta del documento
computarizado
detallando
ls pagos en su solicitud el Seguro de Incapacidad
(Dl) o del Permiso Familiar
Pagado
(PFL). Para
asistirle
a comprender
mejor este documento,
le proporcionamos
la siguiente xplicaci6n.
La parte de arriba del documento
incluye
la siguiente
informaci6n:
SSN: N0mero de Seguro Social
NAME: Nombre
GED: Fecha de Vigencia de la Solicitud
DBA: Cantidad de Beneficios Diarios WBA: Cantidad Semanal de Beneficios MBA: Cantidad Mdxima de Beneficios
BAL: Balance de la Cuenta
PD DAYS: N0mero de Dias Pagados DAYS DISQ: N[mero de D[as sin Derecho a
Beneficios
AMT PD: Cantidad de Beneficios DURC: Fecha Aproximada de Terminaci6n
de su Incapacidad,
de la necesidad de
Pagados
cuido o beneficios para entablar lazos afectivos
La segunda parte del documento que comienza con las letras "ACT' indica las disposiciones que se han tomado
en la solicitud. La primer columna, bajo "ACT" indica el c6digo de la disposici6n tomada:
R:
T:
V:
W:
N:
o:
P:
Q:
A:
B:
Adjuste de Pago
El Derecho a Beneficios
no ha sido Determinado
D: Derecho a Beneficios Negado
E: Periodo de Pago Err6neo
L: Reducci6n de Beneficios
Cheque Perdido Reemplazado
Pago Indebido
Pago
Requisitos para Tener
Derecho a Beneficios
La Decisi6n de no pagarle ha sido Anulada
Sistema de Pago AutomStico
Pago a un Plan Voluntario
Periodo de Espera Reglamentaria
Otras disposiciones
tomadas en la solicitud son indicadas a la derecha del c6digo de la disposicion
tomada:
BGN DT: La fecha del comienzo de la disposici6n
tomada.
END DT: La fecha en que se termina la disposici6n
tomada. Cuando se indica'999999'alfinal de la fecha
significa una fecha indeterminada
futura o hasta que tenga "derecho a beneficios."
NUM DYS: N0mero de dias incluidos en la disposici6n
tomada.
AMT:
Cantidad del cheque, o la cantidad deducida de los beneficios.
ISS DT:
La fecha de emisi6n del cheque, o la fecha en que la disposici6n
fue tomada.
STS:
Actividad del Cheque: 01 - No ha sido Cobrado
06 - Perdido o Robado 0B - Falsificado
02 - Cobrado
07 - Cancelado
11 - Expirado
Si Ud. tiene alguna pregunta despu6s de leer este formulario,
llame al 1-866-658-8846
para solicitudes de Dl y
al1-877-379-3819
para solicitudes de PFL. El acceso al sistema TTY (para personas con impedimentos
de
sordera o audici6n solamente) esta disponible al 1-800-563-2441
para solicitudes de Dl y al 1-800-445-1
312 para
solicitudes
de PFL.
Sidesea informaci6n
acerca de su solicitud delSeguro de Desempleo,
llame al 1-800-300-5616.
DE 2599 Rev. 6 (2-08)
(INTRANET)
Page 2 ot 2
Mrc62/CU
Page: 1 Document Name: unt.it.led
PAYMENT HTSTORY INQUIRY
SSN: 575 13 271,9
NAME: DAIilIEL
K KAUWE
CED: 10 13 08
DBA: 67.28 WBA: 47t MBA: 24492 RWBA:
0.00 BAL:
8478.00 OVPMT: -
PD DAYS: 00238 DAYS DISQ: 00000 AyIT PD: 16014.00
DURC: 12 29 09 A
CERT TO DT: 00 00 00 STAT:
AUTH CRITCL CMT: N ATP: Y
SURG DT: 00 00 00 HOSP DT: 00 00 00 CLM STAT: A SUSP EX: Y FLAG EX: N
STATUS:
EXP DT:
ISS DT STS
ENCLOSURES
DISO3O6
NEXT
BGN
ACT DT
s 061_509
0 060109
r 051809
P 050409
P 042209
P 040809
P 032509
P 031109
r 0311_09
P 022509
PAGE 1 OF NN
D DEAN
END
DT
06L7 09
06r_409
U)JIUY
051709
050309
042109
0407 09
032409
032409
031_009
NUM REASON/
DYS CHK-NUM
014
014
A1
A
UJ-+
0!2
01.4
01_4
0r4
014
0r4
no
nq
oq
09
no
09
09
09
09
csc
ATP
15068270
L499 8 09r_
l.4827349
t4571903
r439421-0
1-42L597"7
0
r-3936483
9 42 .00
9 42 .00
942.00
807 . 43
942 .00
942 . Q0
942 .00
942.00
942.00
06 1s
06 02
uf
z6
05 16
05 01_
04 2L
04 09
Q4 08
03 24
02
vz
02
02
v4
v4
02 00A
2587
00A
00A
00a
00a
OPER ID
223P9493
21,8D577 4
21,8D577
4
21,8D577 4
2r8D02L6
21-8D577
4
2r8D6t98
2t8D0497
2L8D0497
2L8D0594
Date: 6/l-6/2009 Time 9:24:23 AM
Page: 1 Document. Name: untitled
Drs03 06
NEXT
PAYMENT HISTORY INQU]RY
OVERFLOW
K KAUWE
TSS DT
03 05 09
02 20 09
02 0s 09
01 26 09
01 27 09
0l_ 25 09
01_ 09 09
t2 27 08
t2 !2 08
12 02 08
11 74 08
r_0 31_ 08
1_0 30 08
PAGE 02 OF NN
D DEA}J
CED: 10 13 08
SSN: 57 5 13 2719
NAME : DAItrIEL
BGN
END NUM
ACT DT
DT
DYS
P 02t1,09 022409 01-4
P 0201-09 021009 010
P 01_2609 013109 006
F 012609 01,2609 001
T 0r-0809 01_2509 01-8
r 010809 012509 01-8
r L22508 010709 014
T 1,21108 L22408 01"4
r 1,12708 121008 0t4
r 111_308 1,12608 014
T 103008 ltt208 0l.4
P 102008 1_02908 010
w 101308 101_908 007
r 000000 000000 001
REASON/
CHK_NUM
1_3
6 65131
1347163s
L3252L57
l.3084726
v
1283 471.6
1262567 9
1,2400036
L220t27 0
1-l_9
53-343
11,7 3 4887
A}.{T
942.00
672.86
403 .71,
0.00
r2LL.L4
LztL.t4
942.00
942.00
942.00
942 .00
942.00
672.86
0.00
ENCI,OSURES
OPER ID
2I8D51'.| 4
218D577 4
21_8D2806
2r8D577 4
218D577 4
2t8D577 4
2r8D7 630
218D7630
218D7630
2L8D7 630
21-8D7
63 0
2L8D7 630
STS
02
vz
02
vz
02
02
02
UZ
02
UZ
00A
00A
00A
2595
00A
2593
2587
2LBD7 630
ATP
0.00 01- 26 09
2L8D5774
_ _
10 30 08 _ 2503
Date: 6/L6/2009 Time z 9:24:26 ANI