"Request for Payment of Wages Other Than Weekly or Biweekly" - New Hampshire

Request for Payment of Wages Other Than Weekly or Biweekly is a legal document that was released by the New Hampshire Department of Labor - a government authority operating within New Hampshire.

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Download "Request for Payment of Wages Other Than Weekly or Biweekly" - New Hampshire

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Phone:
State of New Hampshire
603.271.0127
Email:
Department of Labor
Inspectiondiv@dol.nh.gov
Request for Payment of Wages Other Than Weekly or Biweekly
RSA 275:43,I
Company Name:
___________________________________________________________________________
Federal Identification Number: _________________________________________________________________
Mailing Address: ______________________________________________________________________________
City/State/Zip: _________________________________________________________________________________
Physical Address: _____________________________________________________________________________
City/State/Zip: _________________________________________________________________________________
Email: _________________________________________ Telephone:___________________________________
Contact Person: _______________________________ Title: _________________________________________
Method(s) of Payment of Wages:
Requested Frequency of Payment:
Cash
Direct Deposit*
Semi-monthly
Check
Payroll Card*
Monthly
Electronic Funds Transfer (EFT)*
*If the employer elects to pay employees by direct deposit, EFT, or payroll card, the employer shall offer employees the option
of being paid with checks drawn on a financial institution convenient to the place of employment at no cost to the employee.
Number of NH Employees Paid Hourly _____________
Number of NH Employees Paid Salary _____________
Hourly Rate Range:
$ _________
$________
Lowest
Highest
Annual Salary Range:
$________
_______
$
Lowest
Highest
Monthly Pay
Semi-Monthly Pay
(1
pay period of month)
(2
pay period of month)
st
nd
_____________
Begins:
_____________
_____________
Begins:
Begins:
Day/date
Day/date
Day/date
Ends:
Ends:
_____________
_____________
Ends:
_____________
Day/date
Day/date
Day/date
Payday:
Payday:
Payday:
Day/date
Day/date
Day/date
_____________
_____________
_____________
Detailed Reason for Request:
Approved
Date
By
Denied
Reason for Denial:
No WC
Incomplete form
No SSF
Pay period dates required
Wages too low
Pay day required
Email: InspectionDiv@dol.nh.gov
QUESTIONS? Call (603) 271-0127
Other_______________________________________
Phone:
State of New Hampshire
603.271.0127
Email:
Department of Labor
Inspectiondiv@dol.nh.gov
Request for Payment of Wages Other Than Weekly or Biweekly
RSA 275:43,I
Company Name:
___________________________________________________________________________
Federal Identification Number: _________________________________________________________________
Mailing Address: ______________________________________________________________________________
City/State/Zip: _________________________________________________________________________________
Physical Address: _____________________________________________________________________________
City/State/Zip: _________________________________________________________________________________
Email: _________________________________________ Telephone:___________________________________
Contact Person: _______________________________ Title: _________________________________________
Method(s) of Payment of Wages:
Requested Frequency of Payment:
Cash
Direct Deposit*
Semi-monthly
Check
Payroll Card*
Monthly
Electronic Funds Transfer (EFT)*
*If the employer elects to pay employees by direct deposit, EFT, or payroll card, the employer shall offer employees the option
of being paid with checks drawn on a financial institution convenient to the place of employment at no cost to the employee.
Number of NH Employees Paid Hourly _____________
Number of NH Employees Paid Salary _____________
Hourly Rate Range:
$ _________
$________
Lowest
Highest
Annual Salary Range:
$________
_______
$
Lowest
Highest
Monthly Pay
Semi-Monthly Pay
(1
pay period of month)
(2
pay period of month)
st
nd
_____________
Begins:
_____________
_____________
Begins:
Begins:
Day/date
Day/date
Day/date
Ends:
Ends:
_____________
_____________
Ends:
_____________
Day/date
Day/date
Day/date
Payday:
Payday:
Payday:
Day/date
Day/date
Day/date
_____________
_____________
_____________
Detailed Reason for Request:
Approved
Date
By
Denied
Reason for Denial:
No WC
Incomplete form
No SSF
Pay period dates required
Wages too low
Pay day required
Email: InspectionDiv@dol.nh.gov
QUESTIONS? Call (603) 271-0127
Other_______________________________________