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):

Telephone Number:

Email:

Job Title:

Employer Information:

Employer Name:

HR Director or Payroll Supervisor Name (if known):

Employer Mailing Address (Street, City, State, Zip):

Employer Phone Number:

Type of Business:

Is this your current employer?

Yes

Payroll Information:

What are your gross wages each pay period? (before taxes)

How often are you paid?

Weekly

Bi-Weekly

Monthly

Other

If other, please explain:

What is the amount of PFL payroll deduction being taken out of your paycheck?

Why is your payroll deduction incorrect? (You may check your deduction by using the Payroll Deduction Calculator)

Too much based on calculator

I signed a PFL waiver form

I’ve reached the annual cap

I don’t work in NYS

Other

If other, please explain:

Has this been a recurring issue? If yes, for how many pay periods?

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:

Yes, I give the Board permission to share my PFL deduction complaint details with my employer.

No, I don't give the Board permission to share my PFL deduction complaint details with my employer.

Complaint Form

Employee Information:

Employer Information:

Payroll Information:

Permissions:

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