Missing Paycheck Dispute Letter PDF

Document a missing paycheck or incorrect pay and request a corrected payroll response in writing.

For personal documentation only. This tool does not provide legal advice.

Payroll dispute details

Document the missing paycheck and request a corrected payroll response.

Employee nameEmployee ID (optional)Employer nameEmployer payroll address (optional)Pay period startPay period endPay dateAmount expectedAmount received (optional)Hours worked (optional)Issue description

Requested resolution

Reissue checkDirect deposit traceCorrected paystubWritten response

Select all that apply.

Sender mailing addressSender phone (optional)Sender email (optional)

Save a copy of the letter and any pay stubs or timesheets.

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Review details before sending; nothing here is legal advice or a substitute for local forms.