Contact CL Wage and Hour Division General Inquiry Form- CL

Wage and Hour Division General Inquiry Form
OMB Control Number 1235-0021
Expiration: 05/31/2027
Please provide as much information as possible in the form below.
If we need to reach you, a Wage and Hour Representative will contact you by telephone or email.
You can also reach us by telephone at 1-866 4 US WAGE (1-866-487-9243), Monday to Friday 8:00 a.m. to 4:30 p.m.
local time. Hours vary by region.
If you are deaf, hard of hearing, or have a speech disability, please dial 7-1-1 to access telecommunications relay
services.
An (*) indicates a required field.

How can the Wage and Hour Division assist you?*
I have a question

I have a potential complaint

I don't know

Tell Us About Yourself
Please select the option that best applies to you.*

I am a current or former worker.
I am a parent, child, or relative of a worker.
Other
I do not wish to provide.

Do you know your employer's zip code?*
Yes

No

Please select the option(s) that best applies to your inquiry.*
Child Labor
I think someone is employing children unlawfully.

Wages and Hours
I didn’t get paid for the time I worked or didn't get my last paycheck.
I wasn’t paid extra for working over 40 hours in week.
I think my employer is incorrectly garnishing my wages.
My employer didn’t give me a pay stub or isn’t keeping records of my hours or pay.

Leave and Breaks
I have questions or concerns about family or medical leave.
My employer doesn’t provide breaks for nursing employees to pump breastmilk at work.
I have questions or concerns about vacation, holiday, or sick pay.

My employer doesn’t provide meal or rest breaks.

Unemployment and Workers' Compensation
I have questions about unemployment benefits.
I have questions about workers’ compensation benefits.

Other
I think my employer misclassified me as an independent contractor.
I think my employer retaliated against me.
I have questions or concerns about working on a federal government contract.
I have questions or concerns about temporary work visas.
I have questions or concerns about agricultural employment.
I have a different issue that is not listed here.

Contact Information
We may need to reach out to you for more information. All discussions with the Wage and Hour Division are confidential. The
following information is requested:
I do not wish to provide my contact information.

First Name*

Last Name*

Please select your Country

United States
Address

City

State

Zip Code

State
Telephone Number*

Email Address*

No phone or email
I do not have a telephone

Preferred Language

I do not have an email address

Best time to reach you:

English

Tell Us About Your Employer
Please provide us with any available information. All fields below are optional.
Name of the organization

Address

City

State

Zip Code

State
Telephone Number

Name of Owner, Manager, or Contact Person

Email Address for Owner, Manager, or Contact Person

What type of organization is it? (e.g. farm, restaurant,
construction, etc.)

How many locations or job sites does the organization have?

Approximately how many people work for the organization in total?

Child Labor Details and Information
Please provide the following information about children working (if known):
How many children work for the organization?

If children are not currently working for the organization, when was the last approximate date that they worked?

Names, ages, and job duties of children
Full
Name

Approx.
Age

Job
Duties

Add Another Person
Names of schools where they attend

What time do they typically start and stop working each day? What days of the week do they typically work?

What types of machinery, tools, or equipment do children use at work?

Were any children injured at work? If so, please describe

Please list any languages (other than English) spoken by the children

Please describe your question or concern in detail.

How did you hear about us?
US DOL Office/Employee

Publications/Media

Website - US DOL

Social Media

Website - Search Engine

Poster

Federal Office Non-US DOL

Other

Word of Mouth

I do not wish to provide

State DOL Office/Local Resource

Submit Form

OMB Control Number 1235-0021
Expiration: 05/31/2027
Paperwork Reduction Act Statement- Persons are not required to respond to this collection of information unless it displays a
currently valid OMB control number. The Department estimates respondents spend approximately 10 minutes providing
information to the agency to complete this collection of information, including the time to review instructions, search existing
data sources, gather, and maintain the data needed, and complete and review the collection of information. The obligation to
respond to this collection is voluntary. If you have any comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour
Division, Room S3502, 200 Constitution Avenue NW, Washington, D.C. 20210