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.
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