So our office may better assist you, please confirm the best phone number to contact you.
Please provide date of birth: *
Please choose the State Agency you need assistance with: *
For EDD cases, please provide EDD CAN (10 digit #) or Disability Insurance Claim number:
For EDD cases, what program did you apply for?
When was the last time you received correspondence from the agency? *
Please provide a detailed summary of the issue you are requesting assistance with. *
Have you contacted another elected official regarding this case? If so, who? *
I acknowledge that I have sought assistance from the Office of Assemblyman Devon Mathis on a matter which may require the release of information contained in records maintained by your agency and which may be prohibited from dissemination by law. I hereby authorize you to release all relevant portions of my records and to discuss matters relating to those records with Assemblymember Devon Mathis and with any authorized member of his staff until this matter is resolved.
Please acknowledge below: *