NOTICE OF REDUCED EARNINGS LAST NAME FIRST NAME SOCIAL SECURITY NUMBER NOTE: Issue a DE 2063 only for the seven-consecutive-day period corresponding to your payroll week. If you pay your workers less often than once each seven days, you must issue a DE 2063 for each calendar week (Sunday through Saturday) of partial unemployment. PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS. EDD USE ONLY Interviewer's Initial AC _________________ EMPLOYER'S STATEMENT FOR THE PAYROLL WEEKENDING DATE: (MM/DD/YY) 1. Gross earnings (before deductions) were (if there were no earnings, enter Ø).................................................................... X $ 2. Did this employee report for all work that was available during this payroll week?............................................................... X Yes No (a) If the answer is "NO" give date(s) (b) REASON: Why is this employee not working full-time? (Check one) Lay off due to lack of work (includes reduction in hours) Discharged Voluntary Quit Enter the last date this employee performed any work in your employment either on or prior to the payroll weekending date shown above: (MM/DD/YY) 3. 4. EMPLOYER CERTIFICATION: I CERTIFY that the amount in Item 1 represents reduced earnings in a week of less than full-time work because of lack of work except as shown in Item 2. ENTER YOUR Company Name Address City ) ( Phone Number Zip Code X Employer Account Number Employer Signature (MM/DD/YY) DATE ISSUED TO EMPLOYEE: ISSUE THIS FORM IMMEDIATELY AFTER PAYROLL WEEKENDING DATE SHOWN ABOVE CLAIMANT: You must complete this section. These questions and your answers are for the payroll weekending date(s) shown on the top of this form. A. Was there any reason other than lack of work why you couldn't have worked full-time each regular workday that week? X (1) If yes, give reason, dates and time you could not work: Yes No B. Did you work for anyone other than your regular employer on any day in that week? (This includes self-employment.) X Yes (1) What is the employer's name? Address: (2) How much did you earn before deductions from that employer whether you were paid or not? ................................. X $ (3) Dates worked to . Reason no longer working: No C. Yes Are you receiving a pension, other than Social Security? ................................................................................................. X Yes (1) If yes, has there been a change in the amount since you last reported it?................................................................... X (2) If there has been a change, enter the new gross amount. ..........................................................................................X $ Explain the reason for the change: Did you have a change of address or telephone number in that week? ............................................................................... X (1) If yes, please provide the information in the space below. If you want federal income tax withheld for that week, mark this block o Yes No No D. E. No CLAIMANT CERTIFICATION: I understand the questions on this form. I know the law provides penalties if I make false statements or withhold facts to receive benefits; my answers are true and correct. I declare under penalty of perjury that I am a U.S. citizen or national, or a non-citizen in satisfactory immigration status and permitted to work by the U.S. Citizenship and Immigration Services. X Your Signature is Required Address City ( ) Telephone Number Zip Code NOTE: THIS CLAIM IS TIMELY ONLY BY CONTACTING THE EMPLOYMENT DEVELOPMENT DEPARTMENT WITHIN 28 DAYS AFTER ISSUED TO YOU. EXCEPTION: IF YOU KNOW THAT YOU WILL BE TOTALLY UNEMPLOYED IN EXCESS OF TWO CONSECUTIVE WEEKS, CONTACT EDD IMMEDIATELY. - Versión en español en el dorso DE 2063 Rev. 26 (8-10) (INTERNET) Page 1 of 2 CU American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF REDUCED EARNINGS LAST NAME FIRST NAME SOCIAL SECURITY NUMBER EDD USE ONLY Interviewer's Initial AC _________________ NOTE: Issue a DE 2063 only for the seven-consecutive-day period corresponding to your payroll week. If you pay your workers less often than once each seven days, you must issue a DE 2063 for each calendar week (Sunday through Saturday) of partial unemployment. PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS. EMPLOYER'S STATEMENT FOR THE PAYROLL WEEKENDING DATE: (MM/DD/YY) 1. Gross earnings (before deductions) were (if there were no earnings, enter Ø).................................................................... X $ 2. Did this employee report for all work that was available during this payroll week?............................................................... X Yes No (a) If the answer is "NO" give date(s) (b) REASON: Why is this employee not working full-time? (Check one) Lay off due to lack of work (includes reduction in hours) Discharged Voluntary Quit Enter the last date this employee performed any work in your employment either on or prior to the payroll weekending date shown above: (MM/DD/YY) 3. 4. EMPLOYER CERTIFICATION: I CERTIFY that the amount in Item 1 represents reduced earnings in a week of less than full-time work because of lack of work except as shown in Item 2. ENTER YOUR Company Name Address City ) ( Phone Number Zip Code X Employer Account Number Employer Signature (MM/DD/YY) DATE ISSUED TO EMPLOYEE: ISSUE THIS FORM IMMEDIATELY AFTER PAYROLL WEEKENDING DATE SHOWN ABOVE SOLICITANTE: Usted deberá completar esta sección. Estas preguntas y sus respuestas son para la semana de pago que termina en la fecha indicada en este formulario. A. ¿Había otra razón, además de la falta de trabajo, por la cual Ud. no podría haber trabajado horario completo cada día normal de trabajo en esa semana?....................................................................................................................................X (1) Si contesta que "sí," proporcione la razón, las fechas y las horas en que no podía trabajar ¿Trabajó Ud. para alguien que no es su empleador normal, cualquier día de esa semana? Sí (Esto incluye trabajos independientes o en su propio negocio)........................................................................................................X (1) ¿Cual es el nombre de ese empleador? Dirección: (2) ¿Cuánto ganó, Ud. antes de deducciones, con ese empleador, aunque todavía no le haya pagado? ...................................X $ (3) Fechas en que Ud. trabajó: del C. al . Razón porque Ud. no siguió trabajando ..................