Minimum Wage and Overtime Complaint Form

This form is used to file complaints under the Pennsylvania Minimum Wage Act of 1968, P.L. 11, No. 5.

 

In an effort to expedite your complaint, the Bureau of Labor Law Compliance encourages you to take advantage of the online or electronic submission of the complaint form.

 

If you choose instead to return a hardcopy version of this form (manual submission), all pages must be completed. Additional information that may be needed and applicable to the specific Law under which your compliant is made may be attached.

The Online Version of the form is designed to work best with Microsoft Internet Explorer 5.0 or later. You can download the latest version of Microsoft Internet Explorer by clicking the "Get Internet Explorer" button to the right: An Online Spanish Version of the form is now available.
If you have additional information including attachments, they can be faxed or mailed. Please refer to the instructions provided below under "Manual Submission."

Download this PDF Version if you would like to print out the form and submit it by fax to 717-787-0517, or by mail to:

 

Bureau of Labor Law Compliance

1301 Labor and Industry Building

651 Boas Street

Harrisburg, PA 17121

Once your claim as been accepted, it will be assigned to one of the following District Offices based on the county of the employer.

 

 

Please direct your questions regarding minimum wage and overtime complaints to the Bureau of Labor Law Compliance, with offices in Harrisburg, Philadelphia, Pittsburgh, and Scranton.