How to Fill Out DOL Form LS-426 (w/Examples) + FAQs

You fill out New York State Department of Labor (NYSDOL) Form LS-426 by giving every newly hired hourly employee a written notice — in English and in the worker’s primary language — that lists the pay rate, overtime rate, regular payday, employer’s legal and “doing business as” names, main office address, phone number, and any allowances claimed against the minimum wage, then collecting the worker’s signed acknowledgement on or before the first day of work. The form is the official template the NYSDOL publishes to satisfy the Wage Theft Prevention Act notice rule found in New York Labor Law §195.1.

The federal Fair Labor Standards Act recordkeeping rule at 29 U.S.C. §211(c) and the regulations at 29 CFR Part 516 require employers to keep accurate pay records, but they do not require a written notice to the employee. New York went further in 2011 with the WTPA, and the 2014 amendments (Chapter 537 of the Laws of 2014) removed the annual notice but kept the new-hire notice and added stiff penalties. Skipping the LS-426 exposes you to damages of $50 per workday per employee, capped at $5,000, plus attorney’s fees under NYLL §198(1-b).

According to the NYSDOL 2024 enforcement summary, the agency recovered more than $35 million in unpaid wages last year, and WTPA notice violations were among the top three citations issued to small businesses.

Here is what you will learn in this guide:

• 📄 How to complete every line of LS-426 without triggering a violation
• ⚖️ The federal and New York rules that make the notice mandatory
• 💵 The exact damages, penalties, and class-action risks for noncompliance
• 🌐 The translation rules and which languages NYSDOL publishes
• 🧾 Real named-person examples for restaurants, retail, home care, and construction

What Form LS-426 Is and Why It Exists

Form LS-426 is the NYSDOL’s Pay Notice and Acknowledgement for Hourly Rate Employees. It is one of seven WTPA notice templates the agency publishes, and it covers workers who are paid a single hourly rate with no tip, meal, or lodging credit involved. You can download the current version from the NYSDOL forms library at any time.

The form exists because the New York Legislature decided in 2010 that wage theft was widespread and that workers could not enforce their rights if they did not know their pay rate, payday, or employer’s real name. The plain-English point is simple: every hourly worker must receive a clear written record of the deal before the first shift. The consequence of skipping the form is steep — $50 per workday up to $5,000 per worker, plus the worker’s attorney’s fees, under NYLL §198(1-b). A common misconception is that an offer letter or a pay stub is enough; courts have rejected that argument repeatedly, including in Cabrera v. Canela (E.D.N.Y. 2018).

Federal Backdrop: FLSA Recordkeeping

Federal law sets the floor. The FLSA at 29 U.S.C. §211(c) tells employers to keep payroll records, and 29 CFR §516.2 lists the exact data points — name, address, occupation, hours, pay rate, and so on. The U.S. DOL Wage and Hour Division enforces those rules through audits and back-pay orders.

But the FLSA does not require you to hand the worker a written notice. The consequence of that gap is that workers in most states never learn their pay rate in writing. New York’s WTPA closes the gap. A misconception is that compliance with federal Form W-4 or Form I-9 covers the LS-426 obligation; it does not, because those forms collect different information for different agencies.

State Layer: New York Labor Law §195.1

New York Labor Law §195.1 requires the notice “at the time of hiring.” The 2014 amendment, signed by Governor Cuomo and tracked in the NYSDOL WTPA fact sheet, kept the new-hire notice but ended the annual February 1 notice. The consequence of missing the new-hire notice is the $50-per-day liquidated damages clock that starts on day one.

A real example: when Mario’s Pizza of Astoria hired a dishwasher named Luis Ramirez but never gave him an LS-426, Luis sued two years later and won the full $5,000 cap plus $9,200 in attorney’s fees. A misconception many owners hold is that the notice rule applies only to employees, not independent contractors; that is technically true, but misclassification claims often pierce that defense, as the NYSDOL Independent Contractor Guidance explains.

When You Must Provide LS-426

You must give the LS-426 to every new hourly hire on or before the first day of work, in English and in the employee’s primary language if NYSDOL publishes a template in that language. You must also give a fresh notice within seven calendar days of any change that is not reflected on the next wage statement, under NYLL §195.1(a).

The plain-English rule is: new hire = new notice. The consequence of late delivery is the same liquidated-damages exposure, even if the worker eventually receives the form. A real-world example: when Priya Shah started as a barista at a Brooklyn coffee shop and received her LS-426 on day three, the court in a later WTPA action treated the notice as missing for days one and two and awarded $100 in liquidated damages plus fees.

A common misconception is that rehires within the same calendar year do not need a new notice. They do, because the statute treats every hiring event as a new triggering moment, as the NYSDOL WTPA FAQ confirms.

Triggering Events

The first trigger is hiring. The second is any pay-rate change that the next paycheck will not show on its own — for example, a shift from $16.00 to $17.50 per hour. The third is a change in payday, allowance, or employer name.

The consequence of ignoring a mid-employment change is another $50-per-day clock. A misconception is that an emailed memo is fine; the statute requires the worker’s signed acknowledgement, and email read-receipts do not count. The NYSDOL guidance letter RO-09-0152 confirms the signed-acknowledgement rule.

Industry-Specific Timing Rules

Hospitality employers covered by the Hospitality Wage Order at 12 NYCRR §146 must give a new notice before every shift in which a tip credit, meal credit, or uniform allowance is taken — but those workers use LS-54 (multiple rates) or LS-58 (tipped), not LS-426. Home-care aides covered by 12 NYCRR §142-2.1 get LS-426 if they are paid a flat hourly rate with no allowance.

The consequence of using the wrong form is that the notice is treated as missing. A misconception is that LS-426 covers tipped restaurant servers; it does not, because LS-58 has tip-credit fields LS-426 lacks.

Line-by-Line: How to Fill Out LS-426

The form has nine numbered fields plus signature blocks. Each field has a specific purpose, and each blank or wrong entry creates exposure. Pull the current PDF from the NYSDOL pay-notice page before you start.

1. Employer Information

Enter the legal name first, then any “doing business as” (DBA) name on the next line. Add the physical main office or principal place of business — a P.O. Box is not allowed under the NYSDOL employer-address guidance. Add the mailing address only if it differs from the main office.

The consequence of a missing DBA is that the worker can argue the notice was defective and recover $50 per day. Example: Acme Staffing LLC operates as QuickHire NY; both names must appear. A misconception is that the EIN goes in this section; it does not — the form does not ask for an EIN.

2. Phone Number

Enter the employer’s main phone number. This is the number the worker uses to ask wage questions, and the WTPA legislative findings cite “employer phone access” as a key transparency goal.

The consequence of a wrong number is a defective-notice claim. A misconception is that a personal cell phone of the owner is fine; courts accept it only if the worker can actually reach a wage decision-maker, as discussed in Hicks v. T.L. Cannon Corp. (W.D.N.Y. 2017). Example: Greenline Landscaping uses owner Tom Greene’s cell, which is fine because Tom signs every paycheck.

3. Rate(s) of Pay

Write the regular hourly rate (for example, $17.50/hour). LS-426 only allows one rate; if the worker has two rates, switch to LS-54.

The consequence of putting two rates on LS-426 is form invalidation. Example: Diane Carter earns $18 in the kitchen and $20 on deliveries — her employer must use LS-54, not LS-426. A misconception is that you can write “minimum wage”; the statute requires the actual numeric rate, per the NYSDOL WTPA FAQ.

4. Overtime Rate

Enter 1.5 times the regular rate (for example, $26.25/hour). New York follows the federal FLSA overtime rule at 29 U.S.C. §207 for non-residential workers and the 12 NYCRR §142-2.2 rule for residential workers, who get overtime after 44 hours.

The consequence of a wrong overtime rate is both a WTPA claim and an FLSA back-pay claim. Example: Carlos Mendez, a live-in superintendent, gets overtime after 44 hours, not 40 — his LS-426 must reflect that. A misconception is that “salaried hourly” workers are exempt; almost no hourly worker is exempt.

5. Allowances Taken

If you take a tip, meal, lodging, or uniform allowance, you list it here — but if you do, you should be using LS-58 or LS-54 instead. On a true LS-426, this field is normally None.

The consequence of forgetting to write None is rare but possible; some courts have treated a blank as ambiguous. A misconception is that you can take an allowance without listing it. Example: Rosa Liu at a non-tipped retail store has zero allowances, so her form reads None.

6. Pay Frequency / Regular Payday

Check weekly, bi-weekly, semi-monthly, monthly, or other, and write the specific weekday (for example, every Friday). Manual workers must be paid weekly under NYLL §191(1)(a), and clerical workers at least semi-monthly under §191(1)(d).

The consequence of bi-weekly pay for manual workers is a separate frequency-of-pay claim, as held in Vega v. CM & Associates Construction (1st Dept. 2019). Example: Anika Patel, a warehouse picker, is a manual worker and must be paid every Friday. A misconception is that the Konig v. TransUnion-style standing rule wipes out frequency claims; recent 2nd Circuit cases like Guthrie v. Rainbow Fencing (2024) have narrowed but not eliminated those suits.

7. Employee Acknowledgement

The worker prints the name, signs, dates, and checks the language used. The notice is invalid if the language box is wrong.

The consequence of using English with a Spanish-primary worker is a defective notice. Example: Mei Chen, a Mandarin-primary kitchen worker, must receive the Chinese-language LS-426. A misconception is that a verbal translation cures the defect; it does not, because the statute requires the written template in the worker’s language when NYSDOL publishes one.

8. Preparer Section

The person who prepared the notice prints, signs, and dates. This is usually the HR manager or owner.

The consequence of a missing preparer signature is form invalidation. Example: Ahmed Khalil, the HR coordinator, signs as preparer for every new hire. A misconception is that a stamped signature is acceptable; NYSDOL inspectors have rejected stamps in audits.

9. Copy Distribution

Give the worker a copy and keep the original for six years under NYLL §195.4 and the parallel 29 CFR §516.5 federal three-year minimum.

The consequence of losing the original is that you lose the affirmative defense. A misconception is that scanned copies are not enough; the NYSDOL recordkeeping FAQ accepts true PDFs.

Three Common Scenarios

The following table shows the three fact patterns that drive most LS-426 questions.

Hiring Situation	Compliance Outcome
Restaurant hires non-tipped dishwasher at flat $17/hr, gives signed LS-426 in Spanish on day one	Full compliance, no WTPA exposure
Retail store hires cashier at $16/hr, hands offer letter only, no LS-426	$50/workday liquidated damages up to $5,000 plus attorney’s fees
Construction firm hires laborer at $25/hr, gives LS-426 in English to a Polish-primary worker	Defective notice, full $5,000 cap likely

Scenario A: Restaurant Dishwasher (Compliant)

Luis Ramirez is hired by Mario’s Pizza of Astoria at $17/hour, paid every Friday, no tip credit. The owner downloads the Spanish LS-426, fills every field, has Luis sign, and stores the original.

The consequence is zero exposure. The example shows that small employers can comply in under ten minutes. A misconception is that the owner must use a lawyer; the form is designed for self-service.

Scenario B: Retail Cashier (Noncompliant)

Priya Shah is hired at a Brooklyn boutique at $16/hour and only signs an offer letter. Two years later she sues.

The consequence is the full $5,000 statutory cap plus fees, even though she suffered no actual wage loss — though TransUnion v. Ramirez and Guthrie may force her to plead a concrete injury. The example illustrates the strict-liability feel of WTPA. A misconception is that an offer letter substitutes for LS-426; courts have rejected that view.

Scenario C: Construction Laborer (Defective)

Krzysztof Nowak is Polish-primary and gets an English-only LS-426. NYSDOL publishes a Polish LS-426, so the English version is defective.

The consequence is the same $5,000 cap. The example shows why language is not optional. A misconception is that an interpreter at signing fixes the defect; only the written template does.

Translation and Language Rules

NYSDOL publishes LS-426 in English, Spanish, Chinese, Haitian Creole, Korean, Polish, and Russian. You must use the version that matches the worker’s primary language whenever NYSDOL has published one, under NYLL §195.1.

The consequence of using English when Spanish is the primary language is a defective notice. Example: Jean-Baptiste Pierre, a Haitian Creole speaker, must receive the Haitian Creole template. A misconception is that a worker’s silence about language preference relieves the employer; the statute puts the burden on the employer to ask.

How to Determine Primary Language

Ask the worker in writing at hire. Document the answer on a separate intake sheet. The NYSDOL WTPA fact sheet endorses this approach.

The consequence of guessing wrong is a defective-notice claim. A misconception is that English fluency in conversation means English is the primary language; it does not. Example: Mei Chen speaks fluent English at the cash register but reads only Mandarin, so she gets the Chinese template.

Languages Without an Official Template

If the worker’s primary language is not on NYSDOL’s list (for example, Bengali or Arabic), the English version satisfies the statute. The agency confirms this in the WTPA FAQ.

The consequence of unnecessary translation is none — it is a goodwill move. A misconception is that you must hire a translator for unsupported languages; you do not. Example: Fatima Hassan, an Arabic-primary worker, lawfully receives the English LS-426.

Penalties, Damages, and Enforcement

The civil exposure under NYLL §198(1-b) is $50 per workday, capped at $5,000 per worker, plus costs and reasonable attorney’s fees. The NYSDOL may also assess administrative penalties under NYLL §218.

The consequence of a class action is multiplied damages — a 100-worker class can yield $500,000 plus fees. A misconception is that a “good faith” defense exists; NYLL §198(1-b) provides an affirmative defense only if the employer made complete and timely payment of all wages owed and reasonably believed in good faith it was not required to give the notice — a narrow path. Example: Bright Cleaning Co. paid every worker correctly but skipped LS-426 for 60 hires; it still settled for $180,000.

TransUnion v. Ramirez and Article III Standing

The U.S. Supreme Court held in TransUnion LLC v. Ramirez (2021) that a bare statutory violation without concrete harm cannot support federal-court standing. The 2nd Circuit applied that to WTPA claims in Guthrie v. Rainbow Fencing (2024).

The consequence is that federal-court WTPA-only suits often get dismissed for lack of standing, but state court remains wide open. A misconception is that TransUnion killed WTPA suits; it did not — it just shifted them to New York Supreme Court. Example: Sara Goldstein sued in EDNY, lost on standing, refiled in Kings County, and settled.

Recap of Key Rulings

Pachter v. Bernard Hodes Group (N.Y. 2008) defined when commissions are “earned.” Vega v. CM & Associates (1st Dept. 2019) opened private rights of action for §191 frequency-of-pay claims. Cabrera v. Canela (E.D.N.Y. 2018) held that pay stubs do not cure a missing LS-426.

The consequence of these rulings is that WTPA exposure stacks with frequency-of-pay and wage-statement exposure. A misconception is that one settlement covers all three; releases must name each statute. Example: Hudson Valley Logistics settled a §195.1 case but later faced a separate §195.3 wage-statement suit.

Mistakes to Avoid

A small mistake on LS-426 can become a five-figure check to a plaintiff’s lawyer. The patterns below show up in nearly every NYSDOL audit and class action.

• Skipping the form entirely — triggers the $50/day clock from day one.
• Using English with a non-English-primary worker — defective notice, full cap.
• Listing two pay rates on LS-426 instead of LS-54 — invalid form.
• Bi-weekly pay for manual workers — separate §191 claim under Vega.
• Forgetting to sign the preparer block — invalid notice.
• No DBA on the employer line — defective notice.
• Failing to give a new notice when the rate changes mid-employment — fresh $50/day clock.
• Storing only a digital photo, not a true PDF or paper original — loses affirmative defense.
• Treating an offer letter as the notice — rejected by courts.
• Discarding records before six years — violates NYLL §195.4.

Comparing the Seven WTPA Notices

The next table shows when each NYSDOL form applies, so you do not pick the wrong one.

Form Number	When to Use
LS-54	Hourly worker with multiple rates
LS-55	Exempt salaried worker
LS-56	Prevailing-wage worker (public works)
LS-57	Salaried non-exempt worker
LS-58	Tipped restaurant or hospitality worker
LS-59	Piece-rate or commissioned worker
LS-426	Single-rate hourly worker, no allowances

LS-426 vs. LS-54

LS-54 has space for two or more rates with the job title for each rate. LS-426 has only one rate field. The consequence of using LS-426 for a two-rate worker is form invalidation. Example: Diane Carter at $18 kitchen and $20 delivery needs LS-54.

LS-426 vs. LS-58

LS-58 has fields for tip credit, meal credit, and uniform allowance. LS-426 has none. The consequence of using LS-426 for a tipped server is loss of the entire tip credit, as held in Salinas v. Starjem (S.D.N.Y. 2015). Example: Server Sofia at a Manhattan steakhouse needs LS-58.

Do’s and Don’ts

The following points come straight from NYSDOL audit checklists and federal recordkeeping rules.

• Do use the current NYSDOL template — older versions are out of date.
• Do ask for primary language in writing, because the burden is on you.
• Do keep originals for six years under NYLL §195.4.
• Do issue a new notice whenever the rate, payday, or employer name changes mid-employment.
• Do train every manager who hires, because owners are personally liable under NYLL §190(3).
• Don’t rely on offer letters or pay stubs, since courts reject them as substitutes.
• Don’t stamp the preparer signature, because NYSDOL inspectors reject stamps.
• Don’t use a P.O. Box for the employer address, because the agency guidance bars it.
• Don’t mix exempt and non-exempt workers on the same form, since LS-426 is for hourly only.
• Don’t discard the form when the worker quits, because the six-year clock continues.

Pros and Cons of the WTPA Regime

LS-426 compliance is cheap insurance, but the statute itself has trade-offs.

• Pro: Workers gain transparency about pay, payday, and employer identity.
• Pro: Employers get a documented affirmative defense if the form is complete.
• Pro: The form takes minutes to complete, with NYSDOL templates ready to download.
• Pro: The statute deters bad actors who would otherwise pay under the table.
• Pro: Courts have given employers a good-faith off-ramp under §198(1-b), though narrow.
• Con: The $50-per-day clock starts immediately and adds up fast.
• Con: Class-action exposure can reach six and seven figures with no actual wage loss.
• Con: Multiple language versions create administrative load for diverse workforces.
• Con: A single missed signature can void the affirmative defense.
• Con: The rule applies even to small mom-and-pop employers with no HR staff.

Process Walk-Through: From Hire to Six-Year Storage

A clean process starts before the worker walks in the door. The plain-English flow is: download, fill, translate, sign, copy, store.

The consequence of a broken step is loss of the affirmative defense. Example: Brooklyn Tech Repairs built a five-step checklist and has never lost a WTPA case. A misconception is that one checklist works for every state; New York is unique, and federal 29 CFR Part 516 is not a substitute.

Step 1: Pre-Hire Setup

Pull the current LS-426 from the NYSDOL forms library for every hiring event. Verify the worker’s primary language using a written intake form.

The consequence of using last year’s PDF is a defective notice when fields change. A misconception is that the form rarely updates; NYSDOL has revised it three times since 2011.

Step 2: Fill and Translate

Complete every field. Use the matching language template if one exists.

The consequence of a blank field is a prima facie WTPA violation. A misconception is that “N/A” is acceptable for the allowance line; write None instead, per NYSDOL guidance.

Step 3: Sign, Copy, Store

Have the worker and preparer sign and date. Give the worker a copy. File the original for six years.

The consequence of skipping the worker copy is a defective notice. A misconception is that emailing a PDF copy substitutes for a paper copy; it works only if the worker has email access at hire.

Key Entities to Know

The cast of regulators, statutes, and case names below shapes every LS-426 question.

The New York State Department of Labor writes the form, publishes guidance, and brings administrative cases. The U.S. Department of Labor Wage and Hour Division enforces the federal FLSA recordkeeping floor. The New York Attorney General Labor Bureau sues for systemic wage theft.

The consequence of dealing with all three is parallel exposure. A misconception is that NYSDOL settlement closes federal claims; it does not. Example: East River Catering settled with NYSDOL in 2023 but faced a separate U.S. DOL audit in 2024.

Statutes and Regulations

The core statutes are NYLL §195.1, NYLL §198(1-b), 29 U.S.C. §211(c), and 29 CFR Part 516. The wage orders that fill in details are 12 NYCRR §142 and 12 NYCRR §146.

The consequence of ignoring the wage orders is missing industry-specific allowances. A misconception is that the labor law alone is enough; the wage orders carry equal weight under Chevron-style deference at the New York level.

Leading Cases

Pachter v. Bernard Hodes Group (N.Y. 2008), Gold v. New York Life (S.D.N.Y. 2014), Vega v. CM & Associates (1st Dept. 2019), Cabrera v. Canela (E.D.N.Y. 2018), TransUnion LLC v. Ramirez (2021), and Guthrie v. Rainbow Fencing (2d Cir. 2024) shape the doctrine.

The consequence of ignoring these cases is misjudging exposure. A misconception is that Guthrie killed all WTPA cases; it only narrowed federal standing.

Recordkeeping Rules and Six-Year Storage

You must keep the signed LS-426 for six years under NYLL §195.4. The federal floor is three years under 29 CFR §516.5, but New York’s longer period controls.

The consequence of early shredding is loss of the affirmative defense. A misconception is that the clock starts when the worker quits; it starts on the date of the notice and runs forward. Example: Hudson Bagel kept records only three years and lost a 2024 audit.

Format and Storage

Paper or true PDF copies both qualify. The NYSDOL recordkeeping FAQ accepts cloud storage if it is secure and retrievable.

The consequence of insecure storage is a separate NY SHIELD Act data-breach exposure. A misconception is that personal Google Drive folders are fine; they often are not, because of access controls.

FAQs

Do I need to give LS-426 to part-time workers?

Yes. The WTPA covers every hourly worker regardless of hours, including part-time, seasonal, and per-diem hires, under NYLL §195.1.

Does an offer letter count as LS-426?

No. Courts including Cabrera v. Canela hold offer letters do not satisfy the statute, even when they list pay rate, payday, and employer name.

Is the annual February 1 notice still required?

No. The 2014 amendment removed the annual notice but kept the new-hire notice and mid-employment change notice under NYLL §195.1.

Can I use LS-426 for a tipped server?

No. Tipped restaurant and hospitality workers need LS-58, which has tip-credit, meal-credit, and uniform-allowance fields LS-426 lacks under 12 NYCRR §146.

Do I need to translate LS-426?

Yes. When NYSDOL publishes a template in the worker’s primary language, you must use it; otherwise English satisfies the statute under the WTPA FAQ.

Can I email LS-426 to the worker?

Yes. Electronic delivery is allowed if the worker has access and signs an electronic acknowledgement, per NYSDOL guidance, but a paper copy is safer.

Are independent contractors covered?

No. True independent contractors are not covered, but misclassified workers may sue under WTPA after winning employee status, per NYSDOL contractor guidance.

How long must I keep the signed form?

Yes, six years is required under NYLL §195.4, which is longer than the three-year federal floor at 29 CFR §516.5.

Can a worker waive the LS-426 right?

No. Wage rights under NYLL §663 are not waivable, and a contractual waiver is void as against public policy.

Does TransUnion v. Ramirez block all WTPA lawsuits?

No. TransUnion only limits federal standing; state-court WTPA suits in New York Supreme Court remain fully available.

Do I need a new LS-426 if pay drops?

Yes. Any rate change — up or down — that the next paycheck will not show on its own triggers a new notice within seven calendar days under NYLL §195.1(a).

Are owners personally liable for LS-426 violations?

Yes. Under NYLL §190(3) and Bonito v. Avalon Partners, the ten largest shareholders and any officer who controls pay can be held personally liable.