Form De 1378N PDF Details

Navigating the intricacies of securing elective coverage for State Disability Insurance (SDI) in California can pose a significant challenge, but understanding the De 1378N form is a crucial step towards achieving this goal for employers. Designed specifically for those seeking SDI coverage exclusively, without the inclusion of Unemployment Insurance benefits, this form caters to a diverse group of employers including public schools, public agencies, Indian tribes, and community college districts. It outlines the necessity for applicants to first verify their eligibility and intent to provide SDI coverage under specific sections of the California Unemployment Insurance Code (CUIC). Ensuring accurate completion of the De 1378N involves providing detailed employer information, delineating the type of employer, and adhering to the prerequisites such as attaching the requisite negotiated agreements or resolutions. Moreover, the form makes it clear that electing coverage is not immediate and highlights the processing steps, including retaining a copy of the DE 1378P for future reference and directing inquiries to the specialized coverage desk. Through careful adherence to these guidelines, employers can navigate the application process more effectively, making the De 1378N form a pivotal tool in extending SDI coverage to their employees under the specific provisions of the CUIC.

QuestionAnswer
Form NameForm De 1378N
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesedd ca gov form de 1326, de1326c, what is de1326cd, de1326cd

Form Preview Example

If your application is approved, the elective coverage agreement will be subject to all of the requirements and conditions outlined in the Information Concerning Elective Coverage for State Disability Insurance ONLY Under Section 702.6, 710.4, 710.5, 710.6, or 710.9 of the California Unemployment Insurance Code (DE 1378P) form. Please retain your copy of the DE 1378P for reference.
******************
Please Type or Print

Taxpayer Assistance Center, Attention: Specialized Coverage Desk, P.O. Box 2068, Rancho Cordova, CA 95741-2068, 916-654-6288

Application for Elective Coverage of State Disability Insurance* ONLY

For Department Use Only

Account No.

Statistical Code

Effective Date

Approved By

Date

Employer Notified

(Date)

Send

Number of Employees

IMPORTANT

This form is not an application for an account number under the compulsory provisions of the California Unemployment Insurance Code (CUIC). Do not complete this form unless you wish to apply for State Disability Insurance coverage ONLY for your employees under Section 702.6, 710.4, 710.5, 710.6, or 710.9 of the CUIC. Coverage under these sections of the CUIC does not make provision for Unemployment Insurance benefits.

Complete this form only for:

1.Employing units with eligible employees who are California residents whose services are covered by the unemployment compensation laws of another state that does not have a disability insurance program under Section 702.6 of the CUIC.

OR

2.Employees of any of the following:

A public school employer under Section 710.4 of the CUIC.

A public agency employer under Section 710.5 of the CUIC.

An Indian tribe under Section 710.6 of the CUIC.

A community college district under Section 710.9 of the CUIC.

NOTE:

1.Name of Employer

 

 

 

 

 

 

(Phone)

 

2.

Business Address

 

 

 

 

 

 

 

(Number and Street)

(City)

(County)

(State)

(ZIP Code)

3.

Mailing Address

 

 

 

 

 

 

 

(Number and Street)

(City)

(County)

(State)

(ZIP Code)

4.Type of Employer – (Check one)

Employing Unit With Eligible Employees – Section 702.6

Public School – Section 710.4

Public Agency – Section 710.5

Indian Tribe – Section 710.6

Community College District – Section 710.9

5.Law under which agency/employer was established. (Does not apply to Indian Tribes.)

(a)

California General Laws

 

 

 

 

 

 

 

 

 

 

 

 

Title of Act

 

 

 

 

Number

 

 

 

Year Enacted

 

 

OR

 

 

 

 

 

 

 

 

 

 

 

(b)

California Codes

 

 

 

 

 

 

 

 

 

 

 

 

Title of Code

 

 

 

 

Number

 

Part

 

 

Chapter

 

 

Sections

 

to

 

 

 

 

 

 

 

 

 

6.Members of governing body of the employer.

Name

 

Title

 

Residence Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Includes Paid Family Leave (PFL).

DE 1378N Rev. 13 (12-13) (INTERNET)

Page 1 of 2

CU

7.This application covers employees of the following appropriate units:

Show Name of Bargaining Unit or Describe Type of Services

Bargaining Unit Management Confidential Unrepresented Academic Other

8.Complete this schedule covering all elected officers and appointees who perform services for the agency named in Item 1. Exclude individuals listed in Item 6.

(a)Elected offices: (These individuals are ineligible for coverage.) Title of Position

(b)Person holding appointive positions: (These individuals are eligible for coverage unless appointed to fill a vacant elected office.)

 

No. of Positions

 

No. of Such Individuals

 

Title of Position

in this Category

By Whom Appointed

Desiring Coverage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(c)Total number of employees to be covered (excluding elected officers and those appointed by the Governor).

9.Deductions should not be made from your employees' wages for the purpose of paying employee contributions required under the CUIC until your election is approved.

10.On what date do you wish elective coverage to commence? Keep in mind that the commencement date of an elective coverage agreement shall not be prior to the first day of the calendar quarter in which the application is filed, nor later than the first day of the following calendar quarter.

First day of current quarter

First day of next quarter

11.Attach a copy of either:

The negotiated agreement between the employer and the recognized employee organization or written petition signed by a majority of the eligible employees to be covered by the election under Section 702.6 of the CUIC.

OR

The resolution in which the governing body described in Item 6 approved the filing of an application for elective

coverage under Section 710.4, 710.5, 710.6, or 710.9 of the CUIC.

******************

The employing unit with eligible employees or governmental or tribal entity described in Item 1 hereby files its application under Section 702.6, 710.4, 710.5, 710.6, or 710.9 of the CUIC to become an employer subject to the CUIC. It is understood that upon approval of the election by the Director, the Employing Unit/Public School/Public Agency/Indian Tribe/Community College District will be an employer subject to the CUIC for State Disability Insurance purposes ONLY to the same extent as other employers as of the date specified in the approval, and will remain a subject employer for at least two complete calendar years and thereafter, until this election is terminated as provided by the CUIC.

I declare that this application has been examined by me, and to the best of my knowledge, it is true and correct and made in good faith under the provisions of the CUIC.

This declaration must be signed by one

(Signed)

 

Date

or more individuals shown under Item 6.

(Signed)

 

Date

 

(Signed)

 

Date

DE 1378N Rev. 13 (12-13) (INTERNET)

Page 2 of 2

CU

How to Edit Form De 1378N Online for Free

You can easily complete documents with the help of our PDF editor. Updating the de1378n file is a breeze in case you keep to the next steps:

Step 1: Search for the button "Get Form Here" on this webpage and click it.

Step 2: Once you've got entered the editing page de1378n, you will be able to discover all of the functions available for the document at the top menu.

The next parts are what you are going to complete to obtain the finished PDF form.

fillable and printable dc1326 edd form blanks to complete

Fill out the Name of Employer, Business Address, Mailing Address, Number and Street, Number and Street, City, City, County, State, ZIP Code, County, State, ZIP Code, Phone, and Type of Employer Check one fields with any data that can be asked by the software.

fillable and printable dc1326 edd form Name of Employer, Business Address, Mailing Address, Number and Street, Number and Street, City, City, County, State, ZIP Code, County, State, ZIP Code, Phone, and Type of Employer  Check one fields to complete

Write down the crucial information in This application covers employees, Show Name of Bargaining Unit or, Bargaining Unit Management, Complete this schedule covering, Title of Position, b Person holding appointive, elected office, Title of Position, No of Positions in this Category, By Whom Appointed, and No of Such Individuals Desiring area.

step 3 to finishing fillable and printable dc1326 edd form

The c Total number of employees to be, Deductions should not be made, under the CUIC until your election, On what date do you wish elective, First day of current quarter, First day of next quarter, Attach a copy of either, The negotiated agreement between, by a majority of the eligible, The resolution in which the, coverage under Section or of, The employing unit with eligible, and I declare that this application segment should be applied to write down the rights or obligations of both parties.

fillable and printable dc1326 edd form c Total number of employees to be, Deductions should not be made, under the CUIC until your election, On what date do you wish elective, First day of current quarter, First day of next quarter, Attach a copy of either, The negotiated agreement between, by a majority of the eligible, The resolution in which the, coverage under Section    or  of, The employing unit with eligible, and I declare that this application fields to insert

Finalize by checking the next sections and typing in the appropriate details: I declare that this application, This declaration must be signed by, Signed Signed Signed, Date Date Date, DE N Rev INTERNET, and Page of.

Entering details in fillable and printable dc1326 edd form part 5

Step 3: If you're done, click the "Done" button to transfer the PDF file.

Step 4: To prevent yourself from any kind of problems in the long run, you should generate at the very least a couple of copies of the document.

Watch Form De 1378N Video Instruction

Please rate Form De 1378N

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .