Request to Investigate – Wage Theft Claim

Request to Investigate – Wage Theft Claim
Please fill out this form to the best of your ability, with the understanding that our office may use the information provided to investigate whether a person, business, or other entity has committed a crime under Texas law.

If you do not know or do not have some of the information requested, you may leave those items blank. However, if you do not provide us with enough information, we may not be able to begin an investigation. When you submit this completed form to our office, please also upload copies of any documents, recordings, or other materials that you have which relate to your claims. You may also submit copies of these records by mail, e-mail, or fax to:

Travis County District Attorney's Office
Public Integrity & Complex Crimes
PO Box 1748
Austin, TX 78767
TCDAwagetheft@traviscountytx.gov
Fax: (512) 854-4810

Do not send us originals but do keep all originals in a safe place in case they are needed for court purposes. Please be aware that the law may require our office to disclose information that it receives about this matter to other parties. Our office cannot guarantee that the information or materials that you provide to us will be kept confidential.

The Travis County District Attorney's Office prosecutes criminal cases on behalf of the State of Texas. We do not represent individual clients in non-criminal cases. For this reason, our office strongly recommends that you also consult with a private attorney about this matter to determine if there are other legal rights or civil remedies that you may be entitled to.
Your Information

Information about you as the victim or complaining witness
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Email Address
Name of Your Company (if applicable)
Your Preferred Language

EnglishSpanishOther

Hiring Company Information

Details about the person or company that hired you
Company or Employer Name*
Company or Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Company or Employer Phone Number
Hiring Person Information

Details about the person who hired you
Name

First NameLast Name
Title
Phone Number
Email Address
License Plate Number
License Plate State
Preferred Language

EnglishSpanishOther
Physical Description
Height, Weight, Eye Color, Hair Color, Race, Sex, etc.
Their Date of Birth or Approximate Age
Was the person or company that hired you performing services for another person or business?

YesNoUnsure
Other Person or Business

Details about the person or business that hired your employer
Name
Phone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code

Emergency Contact

Who is someone that we can contact if we need to speak with you but cannot reach you?
Name

First NameLast Name
Relationship to You
Example: friend, spouse, brother, etc.
Phone Number
Email Address
Preferred Language

EnglishSpanishOther

Description of Your Claim
Describe the exact nature of your complaint and upload all additional materials below. Please be complete. Include the names of the individuals involved in this matter and the dates of all relevant events. If possible, explain what happened in the order the events occurred. With this form, you must provide copies of all relevant documents (see list below). Keep all originals in a safe place in the event they are needed for court purposes.

If you are unable to upload supporting documents below, you can send copies to our office by mail, email or fax:

Travis County District Attorney’s Office
Public Integrity & Complex Crimes
PO Box 1748
Austin, TX 78767
TCDAwagetheft@traviscountytx.gov
FAX: (512) 854-4810
Please explain your claims here:
Please attach copies of all additional evidence that you have which supports your claims, including but not limited to:
- Pay stubs
- Sign-in sheets
- Checks received or bank statements
- Receipts or invoices
- Contracts or services agreements
- Video or audio recordings
- Photos
- Text messages or emails
- Demand letters and return receipts
- Company policies or other documents received from the employer or at the worksite
- Employee badge or other employment identification card
Cancelof
Should be Empty:

Request to Investigate – Wage Theft Claim

Your Information

Hiring Company Information

Hiring Person Information

Other Person or Business

Information About the Alleged Offense

Attempts Made to Recover Money Owed

Emergency Contact

Witness Information

Witness 1

Witness 2

Witness 3

Witness 4

Description of Your Claim