Fwsd10-14.doc - California Employment Development …
TO: Data Analysis Unit
E-Mail ManagePerformance.WSB@edd.
Workforce Services Division
E-FAX: (916) 449-1686
MAIL: P.O. Box 826880, MIC 50
Sacramento, CA 94280-0001
REQUEST FOR CORRECTION TO PREVIOUSLY SUBMITTED DATA
|DATE OF REQUEST: | |
|NAME OF LWIA/SUBGRANTEE: | |
|NAME OF MIS ADMINISTRATOR: | |
|NAME OF REQUESTOR: | |
|EMAIL ADDRESS OF REQUESTOR: | |
|PHONE NUMBER OF REQUESTOR: | |
DETAILED REASON FOR REQUESTED CORRECTION:
(Provide case number, application number, what needs to be corrected, reason for correction, and documentation, below or on an attachment—do not send SSN)
| |
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|AUTHORIZED SIGNATURE OF REQUESTOR DATE: |
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|AUTHORIZED SIGNATURE OF MIS ADMINISTRATOR DATE: |
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|AUTHORIZED SIGNATURE OF EXECUTIVE DIRECTOR DATE: |
|(OR PROGRAM DESIGNEE) |
(The Executive Director’s signature or the Program Designee’s signature must be included when a request is submitted.)
|FOR WORKFORCE SERVICES DIVISION USE ONLY: |
|DAU Analyst Assigned: |
|Date: Approve [ ] Deny [ ] |
|Notes: |
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|Notes: |
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|Date: _________________________ Approve [ ] Deny [ ] |
|Notes: ________________________________________________________________ |
|IT Analyst Assigned: |
|Date notified requestor: |
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