DLSE Form 55 Instructions and Submission Guidelines
This file contains detailed instructions on filling out DLSE Form 55 for claiming unpaid wages. It outlines overtime rules and provides guidance for various scenarios in which the form should be submitted. Use this form to ensure proper handling of wage claims and associated employer responsibilities.
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How do I fill this out?
To fill out this form, gather your work hours and wages details. Make sure to have any records of unpaid wages ready. Follow the step-by-step instructions provided to accurately complete the form.

How to fill out the DLSE Form 55 Instructions and Submission Guidelines?
1
Gather necessary information including employer name and employee details.
2
Enter your pay period dates and your hourly rate of pay.
3
Report any unpaid regular or overtime hours accurately.
4
Review the completed form for accuracy and completeness.
5
Submit the form via the indicated submission methods.
Who needs the DLSE Form 55 Instructions and Submission Guidelines?
1
Employees claiming unpaid wages due to overtime violations.
2
Workers seeking compensation for missed meal or rest breaks.
3
Individuals who have irregular work hours requiring clarification.
4
Employees from agricultural sectors needing specific overtime rules.
5
Truck drivers who need to know their overtime payment obligations.
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What are the instructions for submitting this form?
To submit DLSE Form 55, you can either mail, fax, or submit it online to your local DLSE office. Ensure that all necessary documents are attached and note the case number for tracking purposes. Consult the DLSE website for specific submission addresses or online submission options to ease the process.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, make sure to check the state regulations regarding claim submission deadlines as they may vary. Keep note of your pay periods to accurately fill out your submissions. Ensure timely filing to avoid delays in processing your claims.

What is the purpose of this form?
The purpose of DLSE Form 55 is to ensure that employees can accurately claim unpaid wages from their employers. It outlines the procedures for reporting wage claims, including unpaid overtime and violations related to meal and rest breaks. This form helps facilitate the process of wage recovery for employees who have faced compensation issues.

Tell me about this form and its components and fields line-by-line.

- 1. Employer Name: The legal name of the business or owner.
- 2. Employee Name: The name of the employee claiming unpaid wages.
- 3. Case Number: The state assigned case number for tracking the claim.
- 4. Pay Period Dates: Dates covering the work hours for which payment is being claimed.
- 5. Hourly Rate: The regular hourly wage for the employee.
What happens if I fail to submit this form?
Failure to submit this form properly may result in delays or denial of your wage claim. It is essential to accurately report all necessary details to ensure your claim is processed. Incomplete or incorrect information can hinder your efforts to recover unpaid wages.
- Incorrect Information: Providing false details can lead to claim rejection.
- Late Submission: Submitting after the deadline may result in loss of rights to claim.
- Missing Documentation: Not including required documents can impede processing.
How do I know when to use this form?

- 1. Claim Unpaid Wages: Use this form to report unpaid overtime or regular wages.
- 2. Meal and Rest Period Violations: Submit when your employer fails to provide legally mandated breaks.
- 3. Irregular Work Hours: Claim wages if your work schedule varied significantly.
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