PAGA Amended PAGA Claim Notice

Private Attorneys General Act (PAGA) - Filing

Amended PAGA Claim Notice

Please enter only the eight digit number after "LWDA-CM-" in the following format, "XXXXXX-XX".
Your Information (Attorney or Employee - Whoever is Filing)

Employer Information

Maximum 80 Character Limit

Amended Notice Detail

Additional Employer Information (Corporation/General Partnership)

Maximum 80 Character Limit

Additional Employer Information (Individual/Sole Proprietor)

PAGA Claim Type - Check All that Apply *

Amended Notice

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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.