To request assistance for an issue you are having with a state agency, please submit the following request. Staff will follow up by email for any additional information, if needed, and to provide updates. Due to a large volume of requests, please allow for ________ days before following up with our office.
What is the best phone number to contact you? *
Which state agency can we assist you with?
Have you contacted the agency? *
Applicable Case/Application/Identification Number:
License Number:
EDD Customer Account Number:
Date of Birth: *
Date of Application (if applicable):
When was the last time you received a correspondence from the agency?
Have you contacted another elected official? *
If yes, who have you contacted?
Please provide a detailed summary of the issue. *
Does the Office of Assemblymember Diane Dixon have permission to work with this agency on your behalf? *