Form DE1964 "Claim for Refund of Excess California State Disability Insurance Deductions" - California

What Is Form DE1964?

This is a legal form that was released by the California Employment Development Department - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the California Employment Development Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DE1964 by clicking the link below or browse more documents and templates provided by the California Employment Development Department.

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Download Form DE1964 "Claim for Refund of Excess California State Disability Insurance Deductions" - California

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CLAIM FOR REFUND OF EXCESS CALIFORNIA STATE
DISABILITY INSURANCE DEDUCTIONS
Do not file this claim for a refund unless you are exempt from California state income tax. If you are not exempt from California
state income tax, you must claim your refund on your California income tax return filed with the Franchise Tax Board. Please
complete a separate form for each individual.
First Name and Middle Initial
Last Name
Social Security Number
1.
PLEASE
TYPE
Current Home Address (Number and Street, Including Apartment Number, or Rural Route)
For Tax Year
OR
PRINT
City, Town or Post Office, State, and ZIP Code
Date Filed
Complete schedule below if you worked for two or more employers and deductions for California State Disability Insurance (SDI)
exceeded the amount shown in Column 7(D) below. If California SDI was withheld from your wages by a single employer at more
than the amount shown in Column 7(D) below, contact the employer for a refund.
Actual Deduction For
Wages Paid to You
Wage Summary
2.
SDI, Not to Exceed
During
Dates Employed
Percentage Rate
Employer’s Business Name and City
Do Not Show More
During Calendar
Shown in Column 7(B)
as Shown on Form W-2
Than the Amount
of Wages Shown in
Year
(List in Alphabetical Order)
Shown in Column 7(C)
Column (C). Do Not
*Copies of Form(s) W-2 Must Be Attached.
For Any One Employer
List FICA Deductions.
COLUMN (A)
COLUMN (B)
COLUMN (C)
COLUMN (D)
NAME
LOCATION
FROM (MONTH)
TO (MONTH)
DOLLARS
CENTS
DOLLARS
CENTS
3. Total DI Taxable Wages Paid
4. Total Actual Deductions for SDI (Includes Paid Family Leave Amount)
5. Enter Amount Shown in Column 7(D) for Tax Year
6. Refund Claimed (Line 4 Less Line 5)
7. Table of Maximum wages and Required Contributions
(A) Tax Year
(B) Percentage Rate
(C) Maximum Wages
(D) Maximum Contributions
2016
.9%
106,742
960.68
2017
.9%
110,902
998.12
2018
1.0%
114,967
1,149.67
2019
1.0%
118,371
1,183.71
8. I hereby declare that I am exempt from California state income tax and, therefore, am filing this claim directly with the
Employment Development Department. I further declare under penalty of perjury that the statement of wages paid to me and
contributions deducted, as shown hereon, are true and correct to the best of my knowledge and belief.
Signature
Date
Contact Phone Number
Contact Email
*This request cannot be processed without copies of your Form(s) W-2. The copies of your Form(s) W-2 will not be returned.
DE 1964 Rev. 35 (12-19) (INTERNET)
Page 1 of 2
CLAIM FOR REFUND OF EXCESS CALIFORNIA STATE
DISABILITY INSURANCE DEDUCTIONS
Do not file this claim for a refund unless you are exempt from California state income tax. If you are not exempt from California
state income tax, you must claim your refund on your California income tax return filed with the Franchise Tax Board. Please
complete a separate form for each individual.
First Name and Middle Initial
Last Name
Social Security Number
1.
PLEASE
TYPE
Current Home Address (Number and Street, Including Apartment Number, or Rural Route)
For Tax Year
OR
PRINT
City, Town or Post Office, State, and ZIP Code
Date Filed
Complete schedule below if you worked for two or more employers and deductions for California State Disability Insurance (SDI)
exceeded the amount shown in Column 7(D) below. If California SDI was withheld from your wages by a single employer at more
than the amount shown in Column 7(D) below, contact the employer for a refund.
Actual Deduction For
Wages Paid to You
Wage Summary
2.
SDI, Not to Exceed
During
Dates Employed
Percentage Rate
Employer’s Business Name and City
Do Not Show More
During Calendar
Shown in Column 7(B)
as Shown on Form W-2
Than the Amount
of Wages Shown in
Year
(List in Alphabetical Order)
Shown in Column 7(C)
Column (C). Do Not
*Copies of Form(s) W-2 Must Be Attached.
For Any One Employer
List FICA Deductions.
COLUMN (A)
COLUMN (B)
COLUMN (C)
COLUMN (D)
NAME
LOCATION
FROM (MONTH)
TO (MONTH)
DOLLARS
CENTS
DOLLARS
CENTS
3. Total DI Taxable Wages Paid
4. Total Actual Deductions for SDI (Includes Paid Family Leave Amount)
5. Enter Amount Shown in Column 7(D) for Tax Year
6. Refund Claimed (Line 4 Less Line 5)
7. Table of Maximum wages and Required Contributions
(A) Tax Year
(B) Percentage Rate
(C) Maximum Wages
(D) Maximum Contributions
2016
.9%
106,742
960.68
2017
.9%
110,902
998.12
2018
1.0%
114,967
1,149.67
2019
1.0%
118,371
1,183.71
8. I hereby declare that I am exempt from California state income tax and, therefore, am filing this claim directly with the
Employment Development Department. I further declare under penalty of perjury that the statement of wages paid to me and
contributions deducted, as shown hereon, are true and correct to the best of my knowledge and belief.
Signature
Date
Contact Phone Number
Contact Email
*This request cannot be processed without copies of your Form(s) W-2. The copies of your Form(s) W-2 will not be returned.
DE 1964 Rev. 35 (12-19) (INTERNET)
Page 1 of 2
INSTRUCTIONS
CLAIM FOR REFUND OF EXCESS CALIFORNIA STATE
DISABILITY INSURANCE DEDUCTIONS
CLAIM MUST BE BASED ON CALENDAR YEAR WAGES
A valid State Disability Insurance (SDI) refund claim filed directly with the Employment Development Department (EDD) on this form
must meet ALL of the following conditions:
1.
Claimant worked for two or more employers subject to withholding California SDI.
2.
Deductions for California SDI were made from calendar year wages.
3.
Such deductions exceed the statutory limits.
4.
Claimant declares by signature to exemption from California state income tax.
WHERE TO FILE CLAIM
Employment Development Department, PO Box 826880, Special Processes Group MIC 13, Sacramento, CA 94280-0001.
WHEN TO FILE CLAIM
Claims for credit or refund of California SDI overpayment must be filed within three years after the end of the calendar year in which
the excess deductions were made. The claim must be based on the calendar year in which the wages were received.
AMENDED CLAIMS
Amended claims must be marked as “Amended” (if not, they will be returned to claimant) and forwarded to:
Employment Development Department, PO Box 826880, Special Processes Group MIC 13, Sacramento, CA 94280-0001
INFORMATION FOR COMPLETING WAGE SUMMARY SCHEDULE
1.
The SDI deductions are shown on Form(s) W-2, employer statements, and check stubs.
2.
Most federal, state, and local government agencies are not required to deduct California SDI. Do not include these wages in your
claim unless Disability Insurance deductions were actually made.
3.
Do not include in your claim:
a.
Deductions made from your wages for Social Security and Medicare (FICA), or federal and state income tax withheld from your
wages.
b.
Deductions made from wages earned in states other than California, unless such wages were reported to the State of California.
c.
Seaman’s wages that come under the jurisdiction of states other than California.
4.
Self-employed persons – Enter in Column (A) “Covered under California Unemployment Insurance Code section 708 or 708.5”
and complete Column (B). Failure to enter this information will result in rejection of your claim on initial review.
INSTRUCTIONS FOR COMPLETING DE 1964
1.
Enter all information requested in section 1.
2.
Enter employer information:
Column (A) – All employers and location of job sites, attach Form(s) W-2.
Column (B) – The calendar year dates employed by employer in Column (A).
Column (C) – Wages up to annual maximum shown in section 7(C) paid to you by individual Column (A) employers.
Column (D) – Enter actual amount of SDI withheld. Do not exceed the percentage rate shown in section 7(B) of wages
in Column (C).
3.
Enter total SDI taxable wages paid.
Enter total of all SDI deductions withheld by each employer in Column (D). This amount must be verified by attached Form W-2
4.
copies showing SDI amounts withheld or a statement from the employer indicating the amount of SDI withheld.
5.
Enter maximum contribution for tax year (see Column 7D).
6.
Enter amount of refund claimed (line 4 less line 5).
7.
Table of Maximum Wages and Required Contributions (reference table only).
8.
Read and sign this declaration, which states you are exempt from California state income tax. Without your signature, your claim
will be rejected.
9.
Enter your phone number and date.
ASSISTANCE
If you need assistance in completing this claim, contact the EDD’s Excess State Disability Insurance Unit by calling 1-916-654-8333
or mailing a letter to the address listed above.
DE 1964 Rev. 35 (12-19) (INTERNET)
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