Complaint Form

If you believe there is an error with your current payroll deduction, raise the issue with your employer. If your employer fails to address the issue, you can file a complaint by completing the form below.
 

Employee Information:

Employee Name:
Employee Home Mailing Address (Street, City, State, Zip):

Employer Information:

Employer Name:
HR Director or Payroll Supervisor Name (if known):
Employer Mailing Address (Street, City, State, Zip):
Is this your current employer?

Payroll Information:

How often are you paid?
Why is your payroll deduction incorrect? (You may check your deduction by using the Payroll Deduction Calculator)
Why is your payroll deduction incorrect? (You may check your deduction by using the Payroll Deduction Calculator)

Permissions:

PLEASE NOTE: The Board will contact your employer to notify them of a possible error in the PFL deduction. The letter they will receive is informative and provides guidance on how to accurately calculate an employee’s payroll deduction each pay period. The letter is not specific to your complaint.

If you would like the Board to give your employer specific information about your complaint, including identifying information, (which may assist your employer in looking into and resolving the issue), please indicate ‘YES’ below so the Board has permission to share this information with your employer.

Please Select: