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  • Wage Notice for Upstate Counties

    Notice and Acknowledgement of Pay Rate and Payday Under Section 195.1 of the New York State Labor Law Notice for Hourly Rate Employees

    • Intro Section 

    • {paName}

      This notice is to inform you of a pay increase you will be receiving effective January 1, 2024 for your consumer{consumerName}.

      Due to this pay increase, NY State requires that you receive and sign a copy of this notice. Please complete the required fields below and review the information before submitting this form. You will then be given a copy of the form electronically to save for your records.

    • PA Info Section 
    • Personal Assistant Information
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    • Consumer Info Section 
    • Consumer Information
    • Rest of Form 
    • New Pay Rate
    • Employee's Rate(s) of Pay:

       $ 18.00  per hour for   Mon - Fri  

       $ 18.50  per hour for   Sat - Sun  
      Allowances:  None
      Regular Payday:  Friday
      Pay Frequency:  Bi-weekly
      Overtime Pay Rate(s):  $ 27.00  per hour
    • Employee Acknowledgement
    • On this date, I provided my primary language and I have been notified of my pay rate, overtime rate (if eligible), and designated payday.
    • Clear
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    • Submit Section 
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    • Should be Empty: