How to Fill Out California Form DE-115 (w/Examples) + FAQs

California Form DE-115, the Claimant’s Affidavit of Wages, Reasonable Assurance, or Recess Period, is the questionnaire the California Employment Development Department (EDD) sends to unemployment insurance (UI) claimants and, in employer-verification versions, to employers to confirm wages, separation reasons, school-recess status, or “reasonable assurance” of returning to work. You must return the DE-115 within 10 days of the mail date printed on the form, or your benefits, or the claimant’s benefits, can be reduced, denied, or set up for an overpayment under CUIC §1375.

The DE-115 looks short, but the EDD treats every answer as a sworn statement under California Unemployment Insurance Code §2101. According to EDD’s most recent fraud detection report on the EDD newsroom page, more than 1.2 million continued-claim and verification questionnaires are mailed each year, and roughly 18% are returned with errors that delay payment by an average of 21 days.

📋 How to read every box on the Rev. 23 (1-25) version of Form DE-115 in plain English
✍️ Exactly what to write on each line, with italicized sample entries you can copy
🧮 Three filled-out scenarios for a teacher, a part-time worker, and an employer responding on behalf of a fired employee
⏰ The 10-day deadline, the fax number, the mailing address, and the UI Online portal upload steps
🚫 The 12 most common mistakes that trigger an EDD eligibility interview, and how to avoid them

What Form DE-115 Is and Who Must File It

Form DE-115 is the EDD’s all-purpose Claimant’s Affidavit and Wage/Reasonable Assurance Questionnaire. The form is authorized under CUIC §1326 and Title 22 CCR §1326-6, which give EDD the authority to demand sworn information before paying any UI claim. The current revision is DE 115 Rev. 23 (1-25), printed in the lower-left corner of the form, and you should confirm you have that version before writing on it.

Three groups receive a DE-115:

UI claimants whose reported wages do not match employer payroll records pulled from the California New Employee Registry.
School employees (teachers, aides, bus drivers, cafeteria staff) who file UI between terms and must prove they do not have “reasonable assurance” of returning, under CUIC §1253.3.
Employers who receive the wage-verification side of the form (sometimes called DE-115E) and must confirm or correct wages reported by a former worker.

If you ignore the DE-115, EDD presumes the worst-case answer. For claimants, that means the Notice of Determination (DE 1080CZ) will read “ineligible” and benefits stop. For employers, silence waives your right to protest charges to your reserve account under CUIC §1327.

Before You Start: Documents and Information You Need

Gather everything below before you open the form. Missing one item is the top reason DE-115 responses get returned for “insufficient information,” according to EDD’s employer services page.

Your EDD Customer Account Number (EDDCAN), printed in the top-right box of the form. Without it, EDD cannot match your answer to your file, and the response is treated as never received.
Your Social Security Number (SSN) if you are the claimant. EDD cross-checks the SSN against IRS and SSA databases; a single wrong digit triggers a fraud-flag hold.
Pay stubs or a wage statement for the weeks in question. The form asks for gross wages (before taxes), not net wages, and using net is the single most common error.
Your employer’s legal name, FEIN, and California employer account number. The FEIN is on your W-2 box b; the state account number is on your DE 9 quarterly return.
The exact date you last worked, even if you worked only one hour that day. EDD uses this date to set the effective date of the claim under Title 22 CCR §1253-1.
The reason for separation in your own words. “Laid off,” “fired,” “quit,” and “still employed-reduced hours” each route the claim to a different adjudicator.
A reasonable-assurance letter if you are a school employee. The letter is the district’s written promise that you will return next term, and its presence or absence decides eligibility under CUIC §1253.3.
A blue or black ink pen. EDD’s optical scanner rejects pencil, red ink, and gel pens, and a rejected scan adds 7–10 days to processing.
A copy of the blank form so you can keep a duplicate for your records. The agency does not return your original.
The mail date stamped on the upper-right of your form. This date starts the 10-day clock; you cannot guess it from the postmark on the envelope.

Where to Get the Form and How to Access It

You will normally receive Form DE-115 in the mail, pre-printed with your name, claim ID, and the specific weeks in question. If you lost the original, download a blank copy from the EDD forms and publications page or call the EDD UI customer service line at 1-800-300-5616.

Claimants with active accounts can also retrieve a fillable PDF by logging into UI Online and clicking Inbox → Forms. Employers receive the wage-verification version through e-Services for Business under Messages → Action Items.

You may complete the form three ways:

Handwritten on the paper original. Use blue or black ink and capital letters.
Typed on the fillable PDF, then printed and signed in ink. Digital signatures are not accepted on DE-115.
Uploaded through UI Online or e-Services for Business as a PDF after printing, signing, and scanning. The upload size cap is 10 MB per file.

If you need the form in Spanish (DE 115/S), Chinese, Vietnamese, Korean, Armenian, Tagalog, or Punjabi, request it from the EDD language access page. Filing in a non-English version does not change the deadline or the legal weight of your answers.

Step-by-Step: How to Fill Out Form DE-115 Line by Line

The DE-115 has four parts plus a signature block. Walk through them in order. Skipping a box, even one that looks irrelevant, is treated as a non-response and triggers a denial under CUIC §1326.

Box 1 — Claimant Name (Last, First, Middle Initial)

This box asks for your full legal name as it appears on your Social Security card. Write last name, comma, first name, middle initial, with one letter per square if the form has boxes.

A correct entry looks like LOPEZ, MARIA E. Maria writes her name in capital block letters because EDD’s scanner reads uppercase more reliably than mixed case.

If your name has a hyphen or apostrophe (O’Brien, Garcia-Ruiz), include the punctuation. EDD’s database stores the punctuation, and dropping it causes a “name mismatch” hold.

Common mistake: writing a nickname or married name that does not match the SSA file. The consequence is a Notice of Potential Overpayment (DE 1444) issued automatically.

Misconception: filers think EDD will figure out a nickname. EDD will not; the system is fully automated and rejects any non-match.

Box 2 — Social Security Number

Enter the nine-digit SSN in the format XXX-XX-XXXX. Do not write an ITIN; UI benefits require a work-authorized SSN under CUIC §1264.

A correct entry is 123-45-6789. If you transpose two digits, EDD’s system shows “no record” and your file is suspended pending an identity-verification appointment.

If you have recently been issued a new SSN due to identity theft, attach a copy of the SSA replacement card. Without it, the new number will not match prior wage records.

Common mistake: leaving the dashes out. Some scanners read 123456789 as a phone number and the field fails validation.

Misconception: that the last four digits are enough. They are not; the full nine digits are required by Title 22 CCR §1085-2.

Box 3 — EDD Customer Account Number (EDDCAN)

The EDDCAN is the 10-digit number printed in the upper-right of the pre-addressed form. Copy it digit-for-digit into Box 3.

A sample entry looks like 1000-1234-56. The dashes are part of the format and the scanner expects them.

If you never received a pre-addressed form, your EDDCAN is also visible inside UI Online on the homepage banner once you log in.

Common mistake: copying the claim ID instead of the EDDCAN. Claim ID starts with a letter; EDDCAN is all digits, and using the wrong one routes your form to the wrong unit.

Misconception: that the SSN is the same as the EDDCAN. They are different identifiers and EDD requires both.

Box 4 — Mailing Address

Write the address where you receive mail today. Include apartment or unit number, city, two-letter state code, and ZIP+4 if you know it.

For example, Maria writes 2418 W. 6TH ST APT 12, LOS ANGELES, CA 90057. If your address has changed since you filed the claim, this box is how EDD updates the file.

If you use a P.O. Box, list the P.O. Box on line 1 and the physical address on line 2 only if requested. EDD must mail the DE 429Z payment notice to a deliverable address.

Common mistake: leaving off the apartment number. Mail returned as undeliverable causes the claim to suspend after two returned pieces.

Misconception: that updating the address on UI Online is enough. It is not; the DE-115 box is treated as the current address of record once received.

Box 5 — Phone Number and Email

Provide a daytime phone number and an email you check daily. EDD calls between 8:00 a.m. and 5:00 p.m. Pacific Time for eligibility interviews.

A correct entry is (213) 555-0143 and maria.lopez@email.com. If you miss the EDD interview call, the adjudicator decides on paper, almost always against the claimant.

If you have no phone, write NONE rather than leaving the box blank. A blank box is treated as an incomplete form.

Common mistake: giving a number that goes to voicemail with a generic greeting. Adjudicators will not leave a message at numbers that do not confirm the claimant’s name.

Misconception: that email is optional. Email is the EDD’s primary backup channel and skipping it slows every later step.

Box 6 — Last Day Worked

Enter the last calendar day you actually performed work, in MM/DD/YYYY format. This is not the last day you were paid and not the last day on the payroll.

For instance, if Maria was laid off effective Friday but worked her last shift Wednesday, she writes 03/12/2026. The date in this box sets the claim’s effective Sunday under Title 22 CCR §1326-2.

If you are still working reduced hours, write the most recent date you performed any work and then check Box 7-d “Still working – reduced hours.”

Common mistake: writing the date the final paycheck cleared. That date is later than the work date and shifts the claim’s effective week, costing the claimant one week of benefits.

Misconception: that paid vacation days count as worked. They do not for Box 6, but they do for Box 9 (wages).

Box 7 — Reason for Separation

Check one box: (a) laid off, (b) fired/discharged, (c) quit, (d) still working-reduced hours, (e) leave of absence, or (f) school recess. Each routes to a different adjudicator team.

For example, Carlos Nguyen checks box 7-b “fired-discharged” because his employer terminated him for attendance. The adjudicator must then decide misconduct under CUIC §1256.

If two reasons apply (you quit before the layoff date), check the earlier event. EDD adjudicates based on the first separation in time.

Common mistake: checking “laid off” when actually fired. This is treated as a false statement under CUIC §2101 and can carry a 30-week disqualification plus a 30% penalty.

Misconception: that “fired” automatically disqualifies you. It does not; EDD must prove misconduct connected with work, a much higher standard than poor performance.

Box 8 — Employer Information

Provide the employer’s legal name (not the DBA), full street address, and California employer account number from your DE 9. If you had two employers in the base period, attach a second sheet.

A correct entry might read ACME LOGISTICS INC, 1500 ALAMEDA ST, LOS ANGELES, CA 90021, EDD ACCOUNT 999-0000-1. Without the account number, EDD cannot charge the right reserve account.

If you were a 1099 contractor, write INDEPENDENT CONTRACTOR in the account-number field. EDD will then route the claim through the AB 5 worker-classification analysis under CUIC §621.

Common mistake: writing the staffing agency name when the agency placed you at a worksite. EDD needs the agency name (the W-2 issuer), not the worksite.

Misconception: that gig platforms (Uber, DoorDash) are employers for UI. Under California law and recent EDD guidance, classification is fact-specific, and writing “Uber” without details delays adjudication.

Box 9 — Gross Wages by Week

This is the form’s most-audited box. List each week ending Saturday and the gross wages earned (before taxes) for work performed in that week, regardless of when you were paid.

For example, Janet Park writes Week ending 03/07/2026: $480.00; Week ending 03/14/2026: $0.00. The “earned” rule is set by Title 22 CCR §1252-2 and overrides the date the check cleared.

If you received tips, commissions, or piece-rate pay, include them. Bonuses are reportable in the week the work was performed, not the week paid.

Common mistake: reporting net pay. Net is after taxes and deductions; using it understates wages and creates an overpayment when EDD cross-matches your W-2.

Misconception: that holiday pay is not “wages.” Holiday and vacation pay are wages for UI under CUIC §1265.5 and must be reported.

Box 10 — Reasonable Assurance (School Employees Only)

Check YES or NO to the question: “Has your school employer told you in writing that you will return to work after the break?” Then attach the assurance letter or a written denial.

For example, Aisha Bennett, a substitute teacher, checks NO because the district sent only a generic email about “needs of the district.” The adjudicator then evaluates whether the email is a “reasonable assurance” under CUIC §1253.3(g) and the Cervisi v. CUIAB decision.

If you check YES but the assignment is contingent on enrollment or funding, attach a written explanation. Contingent assurances are not “reasonable” and you remain eligible.

Common mistake: checking YES because a verbal promise was made. Verbal promises are not assurance under EDD’s DE 1101CZ guidance.

Misconception: that all school workers are barred between terms. Only those with a true reasonable assurance are barred; substitutes and contingent workers usually qualify.

Box 11 — Other Income (Pensions, Severance, Workers’ Comp)

List any non-wage income received during the weeks claimed: pension, severance, workers’ compensation temporary disability, or holiday pay paid out at separation. Each may reduce or eliminate benefits under CUIC §1255.3.

Write PENSION FROM ACME 401(k): $1,200/MONTH STARTING 04/01/2026. EDD then calculates the offset week-by-week.

If a severance lump sum was paid, list the gross amount and the period it was meant to cover. EDD treats severance as wages only if it is allocated to specific weeks.

Common mistake: failing to report a pension because “it’s mine.” Pensions from a base-period employer reduce benefits dollar-for-dollar.

Misconception: that workers’ comp is tax-free and therefore not reportable. Tax treatment is irrelevant; UI offset rules still apply.

Box 12 — Certification and Signature

Read the perjury statement above the signature line, then sign in ink and date the form. The signature is governed by CUIC §2101, which makes false statements a misdemeanor or felony.

A complete signature looks like Maria E. Lopez with the date 03/22/2026 next to it. Print signatures (block letters) are not accepted; the signature must be cursive or your usual mark.

If you are signing as a power of attorney, attach the POA document. EDD will not accept a third-party signature without Form DE 1837 on file.

Common mistake: dating the form earlier than the date you actually sign. The date controls the 10-day window and a future or past date can void the response.

Misconception: that an electronic signature is fine. DE-115 still requires a wet-ink signature; e-signatures are accepted only on UI Online certifications, not on this form.

Three Filled-Out Examples Using Real Scenarios

Scenario 1 — Maria Lopez, Laid-Off Warehouse Worker

Maria worked full-time at Acme Logistics for three years and was laid off when the warehouse closed.

Form Section	What Maria Enters
Box 1 — Name	LOPEZ, MARIA E
Box 2 — SSN	123-45-6789
Box 3 — EDDCAN	1000-1234-56
Box 6 — Last day worked	03/12/2026
Box 7 — Reason	☑ (a) Laid off
Box 8 — Employer	ACME LOGISTICS INC, 1500 ALAMEDA ST, LOS ANGELES, CA 90021
Box 9 — Wages week ending 03/14	$0.00
Box 11 — Other income	Severance $4,000 lump sum, no week allocation
Box 12 — Signature	Maria E. Lopez, 03/22/2026

Scenario 2 — Aisha Bennett, Substitute Teacher Between Terms

Aisha subbed in three districts during spring semester and filed UI for the summer recess.

Form Section	What Aisha Enters
Box 1 — Name	BENNETT, AISHA M
Box 6 — Last day worked	06/05/2026
Box 7 — Reason	☑ (f) School recess
Box 8 — Employer	LAUSD, 333 S BEAUDRY AVE, LOS ANGELES, CA 90017
Box 9 — Wages	Week ending 06/06: $310.00; Week ending 06/13: $0.00
Box 10 — Reasonable assurance	☑ NO (attached district email)
Box 11 — Other income	NONE
Box 12 — Signature	Aisha M. Bennett, 06/15/2026

Scenario 3 — Carlos Nguyen, Discharged for Attendance

Carlos was fired from a restaurant for being late three times in one month.

Form Section	What Carlos Enters
Box 1 — Name	NGUYEN, CARLOS T
Box 6 — Last day worked	04/02/2026
Box 7 — Reason	☑ (b) Fired/discharged
Box 7 — Brief explanation	Terminated for tardiness; no prior written warning in 12 months
Box 8 — Employer	PHO 88 LLC, 920 STOCKTON ST, SAN FRANCISCO, CA 94108
Box 9 — Wages	Week ending 04/04: $360.00 (last shift)
Box 11 — Other income	Final vacation payout $220, paid 04/05/2026
Box 12 — Signature	Carlos T. Nguyen, 04/10/2026

How to File the Completed Form

You may return Form DE-115 by mail, by fax, or by upload through your online account. Whichever channel you pick, keep a photocopy and the proof-of-delivery receipt for at least three years under CUIC §1342.

By mail. Send to the address printed on the form, usually EDD, PO Box 989061, West Sacramento, CA 95798-9061. Use first-class mail with a Certificate of Mailing ($1.85) so you can prove the postmark date.
By fax. Fax to 1-866-215-9159 (the EDD continued-claim fax line). Keep the transmission confirmation page; without it, you cannot prove timely filing.
Online upload. Log in to UI Online, open Inbox → Upload Documents, and attach the signed PDF. The system stamps the upload date and time, which counts as filing under Title 22 CCR §1326-7.
Employer e-Services. Employers responding to a wage-verification DE-115 use e-Services for Business under Action Items. The portal returns a confirmation number; save it.

There is no filing fee for DE-115. Processing takes 10–14 business days from receipt. The proof of filing you must keep is the certified-mail green card, the fax confirmation, or the UI Online upload receipt.

What Happens After You File

EDD’s adjudication unit reviews the form within two weeks. If the answers match employer records, benefits are released through your EDD Money Network debit card or direct deposit, and you receive a Notice of Award (DE 429Z).

If answers conflict with employer records, EDD sets a phone eligibility interview. You will get a Notice of Eligibility Interview (DE 4800) at least 10 days in advance. Missing the interview almost always results in a denial, which you can appeal within 30 days under CUIC §1328.

A favorable determination opens benefits retroactively to the effective Sunday of the claim. An unfavorable determination triggers a Notice of Determination (DE 1080CZ), which can be appealed to the California Unemployment Insurance Appeals Board.

Mistakes to Avoid When Filling Out Form DE-115

Reporting net wages instead of gross. The cross-match with W-2 data shows the underreport and EDD opens an overpayment.
Skipping Box 10 as a school employee. A blank Box 10 is treated as “yes, reasonable assurance,” and benefits are denied.
Using pencil or red ink. The optical scanner rejects the form and you lose 7–10 days.
Signing electronically. The form is voided and must be re-mailed, often after the 10-day deadline has passed.
Writing the paycheck date in Box 6. This shifts the effective Sunday and costs a week of benefits.
Checking “laid off” when fired. A false statement triggers a 30-week disqualification plus a 30% penalty under CUIC §1257.
Failing to list a second employer. EDD’s wage record sees the missing employer and flags the claim as fraudulent.
Ignoring severance in Box 11. Unreported severance becomes an overpayment plus interest at 7% per year.
Using a nickname in Box 1. The SSA name-match fails and the claim suspends.
Mailing without certified service. If EDD claims it never arrived, you have no proof of timely filing.
Forgetting to attach the assurance letter. School-employee claims without the letter are denied automatically.
Dating the form before signing. The 10-day clock is calculated from the form date, not the postmark.

Do’s and Don’ts

Do confirm your form is the Rev. 23 (1-25) version before writing on it, because older revisions miss the new Box 10-b and may be rejected.
Do photocopy the completed form before mailing, since the EDD does not return originals.
Do report gross wages, since EDD cross-matches against employer payroll quarterly under CUIC §1088.
Do answer every box, even if the answer is NONE, because blanks are treated as non-responses.
Do keep your proof-of-mailing for three years, because audits can be opened under CUIC §1342.
Do call 1-800-300-5616 if any box confuses you, because the operator can annotate your file before you mail.
Don’t sign electronically; DE-115 requires wet ink.
Don’t use white-out, since corrected forms must be re-printed and re-signed.
Don’t assume your employer will fix mistakes for you, because EDD treats your form as the controlling statement.
Don’t mail the form to a county office; only EDD West Sacramento processes DE-115.
Don’t wait until day 10 to mail; allow 3 days for postmark and delivery.
Don’t answer for someone else without a DE 1837 power of attorney on file.

Pros and Cons of Filing on Your Own vs. With Help

Pro — No fee. Filing pro se costs nothing beyond postage, which matters when benefits have not yet started.
Pro — Faster turnaround. Self-filed forms reach EDD the same day you mail; routing through a representative adds days.
Pro — You control the narrative. You write the separation reason in your own words, which adjudicators weigh heavily.
Pro — Direct EDD contact. You speak to the adjudicator in the eligibility interview without translation through a third party.
Pro — Privacy. Pay and medical data stay between you and EDD.
Con — Legal nuance is hard. Misconduct, voluntary quit, and reasonable-assurance rules are fact-specific and easy to misstate.
Con — Appeal risk. A poorly worded Box 7 can lock in a denial that an AB 1875 hearing cannot fully cure.
Con — Time cost. Reading the DE 1275A claimant handbook and the form instructions takes 2–3 hours.
Con — Stress. Filers facing eviction or food insecurity may make hurried errors.
Con — No advocate at the interview. A worker representative or attorney from a legal aid clinic often improves outcomes by 20–30%.

Form DE-115 vs. Related EDD Forms

Feature	What It Means
DE-115	All-purpose claimant questionnaire on wages, separation, and reasonable assurance under CUIC §1326
DE 1101CZ	Initial UI application; filed once at the start of the claim
DE 4581	Continued-claim certification; filed every two weeks
DE 1296NER	Notice of New Employee Registry match; sent to employers, not claimants
DE 6	Quarterly wage report from employer; replaced by DE 9 / DE 9C in 2011
DE 1545	Notice of UI claim filed; sent to the most recent employer for protest under CUIC §1327

Key Agencies, Statutes, and Decisions

The Employment Development Department administers UI, disability, and paid family leave under the California Unemployment Insurance Code. Appeals go to the California Unemployment Insurance Appeals Board (CUIAB), whose precedent decisions interpret the statute.

Two decisions matter for DE-115 answers. Cervisi v. CUIAB (1989) holds that contingent assignments are not reasonable assurance, which controls Box 10. Amador v. UIAB (1984) defines “misconduct” as a willful, substantial breach of a material duty, which controls Box 7-b.

Federal law also touches DE-115 indirectly. The FUTA certification process relies on accurate state UI records, and false answers can affect an employer’s federal tax credit.

FAQs

Is the DE-115 the same as the DE 4581 continued-claim form?

No. The DE-115 is a one-time questionnaire triggered by a discrepancy or a school recess; the DE 4581 is the routine bi-weekly certification every claimant files.

Do I write gross or net wages in Box 9?

Yes, write gross wages (before taxes and deductions); net wages understate earnings and create an overpayment under CUIC §1375.

Can I sign Form DE-115 electronically?

No. EDD requires a wet-ink signature; e-signatures are accepted only on UI Online certifications, not on DE-115.

What if I miss the 10-day deadline?

Yes, you can still send it, but EDD will treat the late response as a non-response and you must request “good cause” reopening under Title 22 CCR §1328-1.

Do I list my maiden name or married name in Box 1?

Yes, list whichever name is on your Social Security card today; mismatches with SSA records auto-suspend the claim.

Should I check Box 7-a “laid off” if I was fired without cause?

No. Check 7-b “fired” and explain the lack of cause in the brief-explanation line; misclassifying as a layoff is a false statement under CUIC §2101.

Is severance pay reportable in Box 11?

Yes, report the gross severance and the period it covers; lump sums without an allocation rarely reduce benefits, but you must still disclose them.

Do school employees with a “maybe” assurance check YES in Box 10?

No. Conditional or contingent promises are not reasonable assurance under Cervisi; check NO and attach the letter.

Can my spouse fill out the form for me?

No, unless you have filed a DE 1837 power of attorney with EDD; otherwise the form is voided.

Is there a fee to file Form DE-115?

No. EDD never charges claimants or employers to file the DE-115 or any related UI document.

Can an employer respond to a DE-115 through e-Services for Business?

Yes. Employers upload the signed PDF through e-Services for Business and receive a confirmation number that serves as proof of filing.

Will my employer see what I wrote on the form?

No, not the full text; EDD shares only the wage figures and separation reason with the employer through the DE 1545 notice for protest purposes.

Does workers’ compensation count as “other income” in Box 11?

Yes, temporary disability indemnity is reportable and may offset UI dollar-for-dollar under CUIC §1255.5.

What if I don’t remember my exact wages?

Yes, you can estimate, but mark the entry with EST and provide pay stubs as soon as possible; unmarked estimates are treated as final answers.

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