Instructions for Filing an Earned Paid Sick Time Claim
The Earned Paid Sick Time Claim Form should only be used for violations of Arizona’s earned paid sick time laws, including issued related to accrual of earned paid sick time, noncompliance issues, usage of earned paid sick time, earned paid sick time payment complaints, and failure of an employer to post the requiredearned paid sick time noticein the workplace. Do not use this form for an earned paid sick time retaliation claim.
The Earned Paid Sick Time Claim Form must be filled out as completely as possible, including all required fields. Failure to provide required information may delay or result in dismissal of your claim.
To avoid delay in processing an earned paid sick time claim, the Earned Paid Sick Time Claim Form must state the legal name of the claimant’s employer, as indicated on a paystub or tax form. The claimant may submit a paystub, tax form, or other documentation to assist the Labor Department in identifying the correct employer.
An Earned Paid Sick Time Claim Form must be signed and dated by the claimant. Electronic signatures will be accepted.
Please attach to your Earned Paid Sick Time Claim Form copies of any documents or evidence supporting your claim. Evidence showing that Earned Paid Sick Time benefits have not been properly accrued or paid may assist in the investigation process and expedite resolution of your Earned Paid Sick Time Claim. Please do not send original documents or evidence to the Labor Department. The Department is not responsible for the loss or damage of originals.
The completed Earned Paid Sick Time Claim Form may be submitted: (1) Electronically by completing the Sign and Submit Form below; (2) by e-mail to [email protected]; (3) by Fax to (602)-542-8097; or (4) by U.S. Mail to Labor Department, P.O. Box 19070, Phoenix, AZ 85005-9070.
An Earned Paid Sick Time Claim must be filed within 1 year from the date the earned paid sick time violation occurred. Claims pertaining to earned paid sick time violations that are over 1 year old will be dismissed.
You must notify the Labor Department immediately if you move or change your address, e-mail address, or telephone number.