Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law for Home Care Aides Wage Parity and Other Jobs – Department of Labor
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If your preferred language is not English you can translate to your family language:
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Quick guide on how to complete notice:
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- Enter your Full Name: First Name Last Name
- Select “Today”
- Enter your pay rate (Please ask your coordinator if you don’t know)
- Enter your phone number
- Enter your Email address (If you have an Email address)
- Select language
- Sign your name (You can click “clear” button and sign again)
- Enter HR name:
- Click “SUMBIT” Button
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If show up “One or more fields have an error. Please check and try again.”, please double check and click “SUMBIT” button again!
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Success message
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Fill out the 195 form
*If wage supplements are paid as a single payment owed to multiple Taft-Hartley multiemployer plans, list only the following: (1) the total paid for the supplement or benefit package; (2) the types of benefits included in the package, e.g., pension, health and welfare, or other; (3) the name and address of the entity to whom payment is sent; and (4) the relevant CBA or letter of assent as the agreement.