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New Hampshire Department of Labor

In accordance with RSA 275:51 V, any employee who is due unpaid wages may file a wage claim within 36 months from when the wages were due. If you are due unpaid wages from your employer/former employer and you elect to file a wage claim, you must first complete the following Wage Claim form. This page has drawn the IP address 10.12.60.132 from your computer. This information will be stored with your wage claim form for security reasons.

If you need any assistance or have questions regarding this process and wish to contact us by telephone, please feel free to call this Department at 1-800-272-4353 and ask to speak with a Labor Inspector.

If attachments are needed, you will need to download the form and mail to the Department with the attachments.

** In order to receive email confirmation from us, please make sure your bulk email filter is not blocking our IP address. **

You will need Adobe Acrobat Reader (available free from Acrobat Reader) to display your form.

Is this wage claim form being submitted on your own behalf, or by an attorney on behalf of a client?

Own behalf Attorney on behalf of a client

  

Please check off the claim issues that apply to your case.

Unpaid Wages What's this?
Vacation Pay What's this?
Commissions What's this?
Expenses What's this?
Illegal Deductions What's this?
Sick Pay What's this?
Earned Time What's this?
Holiday Pay What's this?
Personal Day What's this?
Liquidated Damages What's this?
Incentive Pay What's this?
Paid Time Off What's this?
Compensatory Time What's this?
Overtime What's this?
Health and Welfare or Pension Fund Contributions What's this?
Severance Pay What's this?

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