Comments, Suggestions, And/or Complaints (DE 8123) 8123 De8123

User Manual: 8123

Open the PDF directly: View PDF .
Page Count: 2

DE 8123 Rev. 6 (10-17) (INTERNET) CU

Comments, Suggestions, and/or Complaints

1. Contact Information

Name

Address

Phone Number

Alternate Number

Email Address

Preferred Language

Did Someone Assist You in Completing This Form? ☐ Yes ☐ No

Name

Phone Number

2. Incident Information

Date of Incident

Location/Address

3. Service Area

☐ Unemployment Insurance ☐ Tax-Related Services ☐ Cannot reach an EDD

representative

☐ Disability Insurance ☐ Paid Family Leave ☐ Other

☐ Workforce Services ☐ CalJobsSM

4. Language Access Issue (check all that apply) ☐ Yes ☐ No

☐ Lack of bilingual personnel

☐ Lack of forms/materials in multiple languages

☐ Lack of signs informing the public of translation services

☐ Other

5. Please enter your comment, complaint, or suggestion in the space provided below.

If additional space is needed, you may use the back of this form or attach an

additional sheet.

6. Would you like a response? ☐ Yes ☐ No

Page 1 of 2

DE 8123 Rev. 6 (10-17) (INTERNET)

Mail the completed form to the appropriate address below.

Unemployment Insurance