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
If your preferred language is not English you can translate to your family language:
Quick guide on how to complete notice:
- 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
If show up “One or more fields have an error. Please check and try again.”, please double check and click “SUMBIT” button again!
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.