How to Complete and File the New York LS 223 Complaint Form

The NY LS-223 complaint form is what you file with the New York State Department of Labor to report unpaid wages, overtime shortfalls, illegal paycheck deductions, denied sick leave, or unpaid fringe benefits. You can download the fillable PDF from the DOL website or submit the same complaint online, and there is no fee either way. The Division of Labor Standards investigates, and if it confirms a violation, it can order your employer to pay what you’re owed plus 100 percent in liquidated damages. You have six years from the date of the violation to file.

What the Form Covers

The LS-223 is split into four claim parts, and you complete only the ones that match your situation. More than one type of violation can go on a single form.

Part 4 — Unpaid wages: Your employer shorted your paycheck, bounced a check, or didn’t pay you at your agreed rate.
Part 5 — Minimum wage and overtime: You were paid below the state minimum wage, didn’t receive time-and-a-half after 40 hours in a workweek, or weren’t paid the extra hour owed when your workday spanned more than 10 hours (spread-of-hours pay).¹
Part 6 — Unpaid paid sick leave: Your employer denied or failed to pay sick leave required under Section 196-b of the Labor Law.²
Part 7 — Unpaid wage supplements: Your employer promised fringe benefits in writing (vacation pay, holiday pay, expense reimbursements, similar items) and didn’t deliver.³

Illegal deductions belong on the form too. Section 193 of the Labor Law bars employers from docking your pay for breakages, cash register shortages, fines, or other business losses, even when a company policy says otherwise.⁴ Meal period violations are also within scope: under Section 162, most workers are entitled to at least 30 minutes off for a midday meal during shifts exceeding six hours, with additional meal periods required for shifts covering both lunch and dinner.⁵

If your claim is for underpayment, check your rate against the current floor. For 2026, New York’s minimum wage is $17.00 per hour in New York City, Long Island, and Westchester County, and $16.00 per hour everywhere else in the state. Fast food workers follow the same split.⁶

What to Gather Before You Start

The form asks for specifics, and incomplete submissions are a common reason cases stall. Pull your records together first so you can fill it in without guessing.

Employer information: The business name as it appears on your pay stubs, the legal name if different, the worksite address, the type of business, and the name and contact details for your supervisor or the owner. If you can find the Federal Employer Identification Number on a W-2 or 1099, include it; it helps the state identify the right corporate entity when a business operates under multiple names.²
Your employment details: Job title, rate of pay, pay frequency, your regular work schedule, and the dates you worked there.
Pay records: Pay stubs, W-2s, 1099s, or bank deposit records showing what you were actually paid. Personal time logs still count if that’s all you have, but official records are stronger.
Your calculation: The form requires dollar amounts for each pay period in dispute. For Part 4, you’ll list the payroll week ending date, hours worked, your rate, gross wages owed, gross wages paid, and the difference. For Part 5, you’ll map out your full work schedule for a typical week, including start and end times and meal breaks.
Written policies: For a wage supplement claim, attach the handbook page or policy document that promised the benefit. Without that written promise, the DOL has limited ability to pursue the claim.

Your preferred language is one of the first fields. The Department uses it to assign staff who can communicate with you directly, so fill it in even if you’re comfortable in English.

Filling Out the Form Section by Section

The LS-223 runs about seven pages. The PDF from the DOL website is fillable, so you can type into it before printing.

Parts 1 Through 3: You and the Employer

These sections collect your name, address, phone, email, and primary language, followed by the employer’s business name, legal name, address, and business type. You’ll also enter your job title, dates of employment, rate of pay, and how you were paid.²

Part 4: Unpaid Wages

Use this part if your employer simply didn’t pay what you earned at your agreed rate. Each row is one payroll week: week ending date, days worked, hours worked, rate of pay, any illegal deductions, gross wages owed, gross wages paid, and the shortfall. A bounced paycheck gets its own field for the check number and payroll week. At the bottom, specify the full date range your claim covers.

Part 5: Minimum Wage and Overtime

Part 5 opens with yes/no questions about whether you were paid below minimum wage, whether you received overtime for weeks over 40 hours, and whether you were paid extra for working two shifts in one day or for workdays longer than 10 hours. Then you fill in a detailed schedule showing start time, end time, and meal break length for each workday of a typical week. That schedule is how the investigator calculates what you’re owed.

Spread-of-hours pay fits here. Under New York regulations, certain workers, particularly in restaurants and hotels, are owed an additional hour at the minimum wage rate whenever the span from the start of their workday to the end exceeds 10 hours, even if some of that time was off the clock for meals.⁷

Part 6: Unpaid Paid Sick Leave

If your employer has five or more employees, or net income over $1 million, Section 196-b requires paid sick leave. List the period you accrued leave, the amount accrued, the dates you tried to use it, your regular rate of pay, and the dollar amount owed. There’s a field to indicate if you were denied the ability to use sick leave at all.²

Part 7: Unpaid Wage Supplements

For each promised benefit, enter the type (vacation pay, holiday pay, expense reimbursement, and so on), the period it was earned, the date payment was due, and the amount owed. Attach the written policy or handbook page that establishes the benefit.³

How to Submit

You have two options. Mail the completed form to:

Division of Labor Standards
Building 12, Room 185B
State Office Campus
Albany, NY 12226⁸

If you mail it, use certified mail with a return receipt and keep a complete copy of everything you send. The DOL also offers an online filing option through its Unpaid/Withheld Wages and Wage Supplements page, linked from the Labor Standards Complaint Process page.⁸ There is no fee to file either way.

What Happens After You File

Once your complaint is logged, the Division of Labor Standards decides whether to open an investigation. Not every complaint is accepted; the Commissioner has discretion over which claims to pursue and how broadly to scope them.²

If your claim moves forward, an investigator contacts the employer by phone, letter, or in person to present the allegations and request payroll records. If the first letter is ignored, a second follows. A field visit to the worksite is sometimes necessary, particularly when violations appear to affect the whole workforce rather than one employee.⁹ The Division can also schedule a compliance conference where you and the employer both discuss the dispute. Timelines depend on whether the employer cooperates and produces records; straightforward cases resolve faster than those requiring subpoenas and repeated follow-up.¹⁰

Order to Comply

If the investigation confirms a violation and the employer still refuses to pay, the Commissioner of Labor issues an Order to Comply. The order includes the unpaid wages plus 100 percent in liquidated damages. On $5,000 in unpaid wages, the order can total $10,000, and civil penalties and interest may be added.¹¹ If the employer ignores the order, the state has authority to place liens on the employer’s property, issue warrants, and seize financial assets.⁸ An employer can appeal the order to the Industrial Board of Appeals, which triggers a formal hearing where both sides present evidence; the appeal adds time, but you don’t lose your right to the money during it.¹⁰

Protection From Retaliation

Your employer cannot fire you, demote you, cut your hours, threaten you, or retaliate in any other way for filing. Section 215 of the Labor Law prohibits it, and the definition is broad: threats to report a worker’s immigration status or a family member’s status, assigning disciplinary points, demotions, and withheld promotions all count.¹²

If the Commissioner finds retaliation, penalties range from $1,000 to $10,000 per violation. Repeat offenders within a six-year window face penalties up to $20,000. The Commissioner can also order reinstatement, back pay, and up to $20,000 in liquidated damages payable to you. You can also sue the employer directly in court within two years of the retaliatory act.¹²

Deadline to File

You have six years from the date of the violation to file a claim for unpaid wages, benefits, or wage supplements. The clock pauses from the date you file your complaint with the Commissioner or the Commissioner opens an investigation, whichever comes first, until the Order to Comply becomes final or the Commissioner tells you the investigation has concluded.¹³

Court Is a Separate Option

Filing with the DOL does not prevent you from suing. Section 198 is explicit that an investigation by the Commissioner is neither required before, nor a bar against, a civil action in court. In court you can recover unpaid wages, prejudgment interest, reasonable attorney’s fees, and liquidated damages of 100 percent (300 percent for willful violations of the Section 194 equal pay provision). Many employment attorneys take wage cases on contingency because the law guarantees fee recovery for the winning side. For straightforward, well-documented claims, the LS-223 route is free and doesn’t require a lawyer; for large or complex cases, consulting an attorney is worth considering, and you can pursue both paths at once.¹⁴

Who Can File

The LS-223 is for anyone who performed work in New York State. You don’t need to be a current employee, and former workers file these claims frequently after realizing they were underpaid. Your immigration status does not affect your right to file; Section 215 specifically bars employers from using immigration threats against workers who assert their rights.¹²

One limitation: the form is for employees, not independent contractors. If your employer classified you as a contractor but controlled your schedule, your tools, and how you did the work, the classification may be wrong. The federal economic reality test looks at factors like your ability to profit or lose through your own decisions, the permanence of the relationship, and the degree of employer control. Labels on paper don’t determine your status; the actual working conditions do.¹⁵ If you think you were misclassified, file the complaint anyway and let the DOL evaluate the relationship.

1
New York State Department of Labor. Overtime Frequently Asked Questions
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New York State Department of Labor. Labor Standards Complaint Form LS-223
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New York State Department of Labor. Wages and Hours Frequently Asked Questions
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New York State Department of Labor. Illegal Deductions
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New York State Department of Labor. Guidelines for Meal Periods LS-443
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NY.Gov. New York State’s Minimum Wage
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Legal Information Institute. 12 NYCRR 146-1.6 – Spread of Hours Greater Than 10 in Restaurants and All-Year Hotels
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New York State Department of Labor. The Labor Standards Complaint Process
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New York State Department of Labor. Notification of Labor Standards Enforcement Process
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New York State Department of Labor. What to Expect from a Labor Standards Wage Claim Investigation
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New York State Department of Labor. P715 – Wage Theft Prevention Act
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New York State Senate. New York Labor Law 215
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New York State Senate. New York Labor Law 198 – Costs, Remedies
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New York State Senate. New York Labor Law 198
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U.S. Department of Labor. Fact Sheet 13 – Employment Relationship Under the Fair Labor Standards Act