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Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

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  • Home
  • Agency Information
    • About Us
    • Commissioners
    • Director's Office
    • Legislation
      • Arizona Statutes
      • Arizona Rules
    • Meetings
      • All Public Meetings
      • Commission Meeting Agendas
      • Meeting Minutes
  • Divisions
    • Administration
      • Accounting
      • Human Resources, Special Services and MIS
      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
      • Boiler Section
      • Elevator Section
      • Occupational Safety and Health (OSHA / ADOSH)
      • Research & Statistics (BLS)
    • Claims Division
    • Labor Department
    • Legal Division
    • Medical Resource Office (MRO)
    • Special Fund Division
  • News and Events
    • Public Notices
    • News and Events
  • Resources For
    • Resources for Employees
    • Resources for Employers
    • Resources for Insurers
    • Resources for Medical Providers
    • Resources for ICA Community
  • How Do I
  • Online Services
    • Forms
    • Self Service Center
    • ICA Community
  • Payment Portal
  • OMBUDSMAN
  • Home
  • Payment Compliance Complaint Form

Payment Compliance Complaint Form

Instructions

 

INSTRUCTIONS FOR FILING A PAYMENT COMPLIANCE COMPLAINT

 

  • The Payment Compliance Complaint Form may be used to file a complaint regarding an employer not paying wages on prescribed paydays; not paying wages at least twice a month; or not providing a pay stub with paid wages.
  • Do not use the Payment Compliance Complaint Form for report unpaid wage, minimum wage, earned paid sick time, retaliation, or youth labor violations.
  • The Payment Compliance Complaint Form must be filled out as completely as possible, including all required fields.  Failure to provide complete information may impact the Labor Department's ability to effectively investigate the complaint. 
     
  • To avoid delay in processing a payment compliance complaint, the Payment Compliance Complaint Form must state the legal name of the employer, as indicated on a paystub or tax form.  The complainant may submit a paystub, tax form, or other documentation to assist the Labor Department in identifying the correct employer.
     
  • Please attach to the Payment Compliance Complaint Form copies of supporting documents or evidence related to the complaint.
     
  • The Payment Compliance Complaint Form can be submitted by: (1) E-Mail to [email protected]; (2) Fax to (602) 542-8097; or (3) U.S. Mail to Labor Department, P.O. Box 19070. Phoenix, AZ 85005-9070. 

 

Sign and Submit Form

Payment Compliance Complaint Form

Printer-Friendly Form

PDF icon Labor_3304 Payment Compliance Complaint Form.pdf

Related Forms

Unpaid Wage Claim Form
Minimum Wage Claim Form
Earned Paid Sick Time Claim Form
EPST/Minimum Wage Retaliation Claim Form
Youth Labor Complaint Form
Payment Compliance Complaint Form

Official Website of the State of Arizona

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Contact Us:

Phoenix Office
800 W. Washington Street
Phoenix AZ 85007
602-542-4661

 

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Contact Us:

Tucson Office
2675 E. Broadway Blvd
Tucson AZ 85716
520-628-5188

 

 

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