How to Fill Out and Submit Form LS223: NY Unpaid Wages Complaint

Form LS223 is the wage complaint form New York workers file with the state Department of Labor to recover unpaid wages, unpaid overtime, illegal paycheck deductions, missing final pay, denied meal breaks, or promised benefits an employer refused to pay. You complete the numbered parts with your information, your employer’s information, your employment details, and a week-by-week tally of what you’re owed, then sign it and either mail it to the Division of Labor Standards in Albany or file the equivalent claim through the DOL’s online portal.¹

What LS223 Covers

The form is built around several distinct claim types, and each has its own section. You can raise more than one on a single filing. If your employer paid below minimum wage and also took deductions you never authorized, both belong on the same LS223.

Unpaid minimum wage. As of January 1, 2026, the minimum wage is $17.00 per hour in New York City, Nassau, Suffolk, and Westchester counties, and $16.00 per hour in the rest of the state.²
Unpaid overtime. Most employees are owed one and a half times their regular rate for hours over 40 in a workweek.³
Illegal deductions. Employers can’t take money from your check unless the law requires it or you authorized it in writing for something that benefits you.⁴
Late or missing paychecks. Pay-frequency rights vary by worker type, with manual workers entitled to weekly pay within seven days of the pay period’s end.⁵
Unpaid wage supplements. Part 7 covers vacation pay, sick leave, bonuses, or other benefits promised in a written policy. You must attach a copy of the policy.
Denied meal periods. Most workers are entitled to at least a 30-minute uninterrupted meal break, and working through one can trigger additional pay.⁶

Independent contractors aren’t covered by New York’s wage and hour laws, so the form is for workers who qualify as employees. Job titles don’t decide it; whether the business controls your schedule, tools, and methods does. A salaried worker labeled “exempt” can still file if the actual duties don’t meet the exemption test.⁷

Filling Out the Form Part by Part

The LS223 is organized into numbered parts. Pull together your pay records and your employer’s legal information before you start, so you’re not stopping mid-form to look things up.

Part 1: Your Information

Full name, address, phone number, and email. Use a current mailing address. The DOL sends your case number and all follow-up correspondence by mail.

Part 2: Employer Information

Enter the business name your employer uses day to day and, if different, the legal name registered with the state. Include the name and title of the owner or officer in charge, and identify the entity type: individual, LLC, partnership, corporation, or other. The DOL uses that to determine who gets served with legal notices.⁸ Add the full mailing address, phone, and email.

If you’re not sure of the legal name or entity type, the New York Department of State’s business entity database is searchable online. A complaint directed at the wrong legal entity can delay your case.

Part 3: Employment Details

Hire date, last day worked, job title, rate of pay, and how you were paid (hourly, salary, piece rate). The form also asks about your usual schedule and weekly hours. Be specific. If your hours varied, give the range.⁸

Part 4: Unpaid Wages Claim

This is where the money gets laid out. The form provides a weekly grid: list each workweek, the hours you worked, what you were paid, and what you should have been paid. If you need more space, attach a separate sheet; the form says so directly.⁸

For a minimum wage claim, multiply the hours you worked each week by the applicable rate, then subtract the gross pay you received. For overtime, find every week you worked more than 40 hours, calculate one and a half times your regular hourly rate, and apply that rate to the excess hours. The gap between what you got and what you should have gotten is your claim.

If a paycheck bounced, the form has a specific field for it. Provide the check number and the payroll week ending date, and attach a copy of the dishonored check if you kept one.

Part 7: Wage Supplements

If you’re claiming unpaid vacation, sick pay, bonuses, or similar benefits promised in writing, attach the handbook page, offer letter, or written policy that describes the benefit. Without the written policy, the DOL has nothing to enforce.

Documents to Have on Hand

You don’t have to submit a stack of evidence with the initial filing, but records strengthen the claim and speed the investigation.

Pay stubs, which show actual pay and any deductions.
Your own time logs, even from a notebook or phone app, to fill gaps if the employer’s records are missing or disputed.
Bank statements confirming direct deposit dates and amounts.
Emails, texts, or letters about pay rates, schedules, or promised benefits.
Employment contracts or offer letters that spell out pay or benefits.
Company handbooks or policies (required for Part 7 wage-supplement claims).

Federal law requires employers to keep payroll records for at least three years and time cards and schedules for at least two years.⁹ The DOL can demand records from your employer during the investigation, but relying entirely on the employer’s version puts you at a disadvantage if those records are incomplete. Keep what you can.

How to Submit Form LS223

You can mail the completed and signed form to:

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

Or you can file the equivalent claim through the DOL’s “Unpaid/Withheld Wages and Wage Supplements” online portal, which the agency’s complaint-process page points to directly.¹ Online is usually faster because there’s no mail delay.

Either way, you must sign and date the form. You’re submitting it under penalty of perjury, so everything you write needs to be accurate. If you mail, use certified mail with return receipt requested. Keep a photocopy of the entire packet, including any attachments.

What Happens After You File

The DOL runs a preliminary review to confirm the form is complete and the claim falls within the Division of Labor Standards’ authority. If it’s accepted, you’ll get a case number (an “LS#”) by mail.¹ Use that number on all future communications.

An investigator then contacts your employer by phone, letter, or in person. The employer gets to respond and is typically asked to produce payroll records so the investigator can compare them against what you reported. A workplace visit is more likely when the employer doesn’t respond or when violations appear to affect multiple workers.¹⁰

If the investigation confirms a violation, the DOL first tries to get the employer to pay voluntarily. When that fails, the Commissioner of Labor issues an Order to Comply.¹ The employer has 60 days to appeal to the Industrial Board of Appeals, and that deadline is strictly enforced.¹¹

How Far Back You Can Go

You have six years to bring a wage claim under New York Labor Law, and the clock runs separately for each missed or shorted payment. If your employer underpaid you every week for three years, each weekly shortfall carries its own six-year window.¹² The same six years applies to minimum wage claims.¹³

Filing with the DOL pauses (tolls) the statute of limitations until the Commissioner’s order is final or the DOL closes the investigation. Filing an LS223 does not block you from bringing a private lawsuit; the two paths can run in parallel.¹²

Retaliation Is Illegal

Your employer can’t fire, demote, cut hours, or otherwise punish you for filing a wage complaint. Section 215 covers complaints made to the DOL, to the Attorney General, to your employer, or even to a coworker, and your complaint doesn’t need to cite a specific statute to be protected.¹⁴

Protected ground is broad. It includes threats to report you or family members to immigration authorities, assigning demerit points that could lead to discipline, and other penalizing behavior. If retaliation follows your LS223 filing, that retaliation is itself a separate violation you can report.¹⁴

What a Successful Claim Can Recover

A win on the LS223 can bring in more than the back wages themselves.

The full unpaid wages, going back up to six years from the filing date.¹²
Liquidated damages of up to 100 percent of the unpaid wages, effectively doubling recovery, unless the employer proves a good-faith belief it was paying you correctly. For willful violations of the equal-pay requirements under Section 194, liquidated damages can reach 300 percent.¹²
Prejudgment interest under New York’s civil practice rules, added on top of wages and liquidated damages.
Reasonable attorney’s fees if you hire a lawyer and prevail in a civil action.¹²
A 15 percent increase on the total judgment if the employer still hasn’t paid 90 days after a court judgment becomes final.¹³

The liquidated-damages piece is the reason many employers settle quickly. If you’re owed $5,000 in back wages and the employer can’t show an honest mistake, the payout doubles to $10,000 before interest and fees are added. That’s what makes a well-documented Part 4 worth the time it takes to complete.

1
New York State Department of Labor. The Labor Standards Complaint Process
2
New York State Department of Labor. Minimum Wage
3
New York State Department of Labor. Overtime Frequently Asked Questions
4
New York State Senate. New York Labor Law 193 – Deductions From Wages
5
New York State Senate. New York Labor Law 191 – Frequency of Payments
6
New York State Department of Labor. Labor Standards Complaint Form for Individuals
7
U.S. Department of Labor. Fact Sheet 17A – Exemption for Executive, Administrative, Professional, Computer and Outside Sales Employees Under the FLSA
8
New York State Department of Labor. NY Labor Standards Complaint Form LS223
9
U.S. Department of Labor. Fact Sheet 21 – Recordkeeping Requirements Under the Fair Labor Standards Act
10
New York State Department of Labor. What to Expect From a Labor Standards Wage Claim Investigation
11
Industrial Board of Appeals. Hearings
12
New York State Senate. New York Labor Law 198 – Costs, Remedies
13
New York State Senate. New York Labor Law 663 – Civil Action
14
New York State Senate. New York Labor Law 215 – Retaliation