PAGA New PAGA Claim Notice

Private Attorneys General Act (PAGA) - Filing 

New PAGA Claim Notice 

Your Information (Person Who is Filing)

(Enter "in pro per" if you are representing yourself)

Plaintiff Information

Employer Information

Maximum 80 Character Limit

Add additional defendants
Additional Employer Information (Corporation/General Partnership)

Maximum 80 Character Limit

Additional Employer Information (Individual/Sole Proprietor)

Notice General Information

Filing Fee
A filing fee of $75 is required to file a new PAGA claim notice. Filing fees should be paid by check, made out to LWDA, and sent by regular mail to:
           Department of Industrial Relations
           Accounting Unit
           455 Golden Gate Ave, 10th Floor
           San Francisco, CA 94102

The check should be accompanied by a cover letter with sufficient information to identify the notice, including the LWDA case number assigned upon submission of this form.
Parties requesting in forma pauperis status should complete a Confidential Request to Waive Court Fees (Judicial Council Court Form FW-001) or similar form and submit it online with the notice below. 

Notice and Other Attachments

Must be a PDF

Should you have questions regarding this online form, please contact

IMPORTANT NOTICE OF REDACTION RESPONSIBILITY: All filers must redact: Social Security or taxpayer identification numbers; dates of birth; names of minor children; & financial account numbers. This requirement applies to all documents, including attachments.