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Industrial Commission of Arizona

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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
    • Data & Statistics
    • 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
  • Home
  • Payment Compliance Complaint Form

Payment Compliance Complaint Form

 

INSTRUCTIONS FOR FILING A PAYMENT COMPLIANCE COMPLAINT

 

  • The Payment Compliance Complaint Form is used to file a complaint regarding an employer for 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 reporting unpaid wages, minimum wage violations, earned paid sick time violations, 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.
     
  • The Payment Compliance Complaint 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.
     
  • You may submit any supporting documents or evidence related to your Payment Compliance Complaint by e-mail, fax, or U.S. Mail (see above).  Please do not send originals of documents or evidence to the Labor Department.  The Labor Department is not responsible for the loss or damage of originals.

 

Required Forms

Form Name Last Updated
Payment Compliance Complaint Form 06/27/20
Payment Compliance Complaint Form 06/27/20
Payment Compliance Complaint Form 06/27/20

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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