Ls223 form ny 2026

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The document is a claim form for unpaid wages issued by the New York State Department of Labor. It requires employees to provide personal information, details about their employment, and specifics regarding the unpaid wages they are claiming. The form includes sections for identifying the employer, work history, wage calculations, and any union involvement. It emphasizes that assistance can only be provided if the employee has previously requested their due wages.

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Click ‘Get Form’ to open the ls223 form in the editor.
Begin by entering your full name and address in the designated fields. Ensure that you print clearly for accurate processing.
Provide your Social Security number and contact information, including both day and evening telephone numbers.
Fill in details about your employer, including their trade name, corporation name (if applicable), and main office address.
Indicate your position within the firm, date hired, last day worked, and your latest agreed rate of pay.
Complete the section regarding your employment status and reason for leaving. If applicable, provide union information.
Calculate the wages claimed for the specified period and ensure all amounts are accurately filled in.
Review all entries for accuracy before signing and dating the form at the bottom.

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