Form Ls 223 PDF Details

When workers in New York find themselves not being paid the wages they've earned, the Ls 223 form becomes a crucial tool in seeking justice. This document, officially known as the "Claim for Unpaid Wages," is provided by the New York State Department of Labor's Division of Labor Standards. It's designed for employees to formally report instances where their employer has not paid them for their labor, including cases of underpayment or non-payment. Completing this form requires providing detailed information about the employment situation, including personal identification, employment details, and specifics about the wages claimed to be owed. One notable stipulation is the requirement that claimants must have requested the unpaid wages from their employer before the Department of Labor can take action on their behalf. Additionally, the form excludes certain employees, such as those in administrative, executive, or professional roles making over $900 gross per week, under Section 190.7 of the New York State Labor Law. By compiling this data, including the employer’s refusal to pay and any checks returned not honored, the form enables the Labor Department to pursue the unpaid wages on behalf of the employee, emphasizing the importance of submitting accurate and truthful information. This process underscores the rights workers have to be compensated for their labor and the legal mechanisms in place to enforce these rights.

QuestionAnswer
Form NameForm Ls 223
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameshow to claim unpaid wages, claim unpaid, new york unpaid wages, ls 223 form

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New York State Department of Labor

Division of Labor Standards

Claim for Unpaid Wages

Please answer all questions on both sides - please print clearly

For Office Use Only

W

Identification Number

Refer to wage suppll. I.D. No. if any)

Taken By

Section 190.7 of the New York State Labor Law excludes from wage payment coverage those persons in an administrative, executive or professional capacity whose earnings exceed $900 gross per week

Note: It is necessary for you to have asked for the wages due before we can assist you.

 

 

1. Your Full Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Social Security No.

 

 

 

Ms.

Mrs.

Mr.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Your Address

 

Apt. No.

City, Town or Village

 

County

 

 

 

 

 

 

Zip Code

 

4. (Area Code) Telephone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Day

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Evening

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Claim against (Trade Name of Employer)

 

 

 

 

 

 

 

 

 

 

6. Corporation Name, if any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Address of main office or headquarters of firm

 

City, Town or Village

County

 

 

 

Zip Code

 

8. (Area Code) Telephone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. Names and addresses of responsible persons of firm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Their positions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. Kind of business firm engaged in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Is firm still in business?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. What was your work or occupation with this firm?

 

 

 

 

 

 

 

13. Address where you worked

 

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. Date Hired

 

 

 

15. Name and Position of person hiring you

 

 

 

16. Name of superintendent, manager or foreman

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17. Latest agreed rate of pay

 

18. Last Day Worked

 

19. Status with Firm

 

 

 

 

 

 

20. Reason for quitting, discharge or layoff

 

 

 

(per hour per week, per day)

 

 

 

 

 

 

 

 

 

I quit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I was discharged

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I was temporarily laid off

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am still employed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21. Were you a member of any union when

 

If “yes”, give name, local no., address, zip code and telephone no. of union

 

 

 

 

 

 

 

 

employed by this firm?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22. Have you asked your union for assistance?

 

If “yes” what action has the union taken?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Before answering questions 23 and 25, first fill out back of this form to help you figure wages due

 

 

 

 

 

 

23. Wages claimed for period (first date to last date)

 

 

24. Name and address of employer’s bank

Zip Code

25. Total amount of wages due

 

 

 

From

 

To

 

 

Inclusive

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26. Did you request these wages?

 

 

 

 

 

 

 

 

27. Date of Request

 

28. To whom was the request made?

 

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29. Did employer refuse to pay for these wages?

 

 

 

 

 

 

If “yes”, give employer’s reason for refusal

 

 

 

 

 

 

 

 

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30. Were any payments due you paid by checks returned not honored?

 

No

Yes

If “yes”, submit photocopies of check(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31. How were wages paid?

 

 

Cash

Check

 

Other (Explain)

 

32. What was your normal payday?

 

 

 

What period did this cover?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Any false statements knowingly made are punishable as a class A misdemeanor (Section 210.45, the New York State penal law). I affirm that the above statements are true.

I authorize the Commissioner of Labor, deputies or agents to receive, endorse my name on, and deposit in the account of the Com- missioner of Labor any checks or money orders made out to me as payment on this claim.

Signature of Claimant

 

Date

(Continue Over)

LS-223 (02-08)

W

Commission Salesperson - Note:

Claims for wages should be recapitulated on Form LS-223.1 (Commission

 

Salesperson Summary Sheet) indicating (1) average weekly earnings

 

including salary, draw and commission; (2) terms of contract and (3) for

 

commissions claimed to be owing, the date of sale, customer’s name, amount

 

of sale, rate of commission and commission due.

All other employees: Wages claimed on other side are to be computed as follows:

33.

Payroll

week

ending

date

34.

Number of hours worked this week

35.

Number of days worked this week

36.

Rate of pay

(show whether by hour, day, week or month)

37.

Total

gross wages*

earned this

week

38.

Gross

wages paid

to you

this week

39.

Difference

between gross wages earned

&gross wages paid to you this week

40.

If wages were

paid by check(s)

not honored

enter the check

number(s)

$per

$

$

$

41. Total

Amount Due

*Gross wage is the amount before taxes or other monies are deducted.

$

42. Include any additional information below:

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1. Firstly, once completing the ls 223 form, start in the page that contains the subsequent fields:

how to new york labor claim conclusion process detailed (step 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Were you a member of any union, Yes, If yes give name local no address, Have you asked your union for, If yes what action has the union, Yes, Wages claimed for period first, Name and address of employers bank, Zip Code, Total amount of wages due, Before answering questions and, From Did you request these wages, Inclusive, Yes, and Date of Request with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

how to new york labor claim completion process explained (part 2)

3. This next section is pretty easy, date, Number of hours worked this week, Number of days worked this week, week or month, week, this week, paid to you this week, numbers, per, Gross wage is the amount before, Include any additional, Total, and Amount Due - each one of these empty fields must be completed here.

Guidelines on how to complete how to new york labor claim stage 3

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