Final Paycheck Acknowledgment Form

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Final Paycheck Acknowledgment Form

A final paycheck acknowledgment form is used to document that an employee leaving a company has been delivered their final paycheck. It states whether any vacation pay is included in the final payout and if any deductions have been made.

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Last updated July 2nd, 2025

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A final paycheck acknowledgment form is used to document that an employee leaving a company has been delivered their final paycheck. It states whether any vacation pay is included in the final payout and if any deductions have been made.

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Final Pay Laws

State laws outline when an employee is entitled to receive their final pay. In South Carolina, employers may withhold an employee’s final pay until all company equipment has been returned to them.[1]

In some cases, penalties are incurred if an employer fails to deliver payment by the due date. Arkansas employers are obliged to pay double the wages owed if they do not deliver final pay on time.[2] 

Final Paycheck Due Date – Laws (By State)
State Employee fired? Employee resigns? Statute
AL Not mentioned in statutes. Not mentioned in statutes. N/A
AK Within 3 workdays. Next payday (at least 3 days after notice to quit is given). §23.05.140(b)
AZ Within 7 workdays or next payday (whichever is first). Next payday. §23-353(a)-(b)
AR Next payday. Not mentioned in statutes. §11-4-405(a)
CA Immediately. Within 72 hours (or immediately if 72-hour notice is given). §§ 201(a), 202(a)
CO Immediately. Next payday. §8-4-109(1)(a)-(b)
CT Next business day. Next payday. §31-71c(a)-(b)
DE Within 3 workdays or next payday (whichever is later). Within 3 workdays or next payday (whichever is later). §1103(a)(1)
FL Not mentioned in statutes. Not mentioned in statutes. N/A
GA Not mentioned in statutes. Not mentioned in statutes. N/A
HI Immediately (no later than next workday). Next payday. §388-3(a)-(b)
ID Within 10 workdays or next payday (whichever is earlier), or within 48 hours if requested. Within 10 workdays or next payday (whichever is earlier), or within 48 hours if requested. §45-606(1)
IL Immediately (no later than next payday). Immediately (no later than next payday). §115/5
IN Next payday. Next payday. §22-2-9-2(a)
IA Next payday. Next payday. §91A.4
KS Next payday. Next payday. §44-315(a)
KY Within 14 days or next payday (whichever is later). Within 14 days or next payday (whichever is later). §337.055
LA Within 15 days or next payday (whichever is earlier). Within 15 days or next payday (whichever is earlier). §631(A)(1)(a)-(b)
ME Not mentioned in statutes. Next payday. §626
MD Next payday. Next payday. §3-505(a)
MA Immediately. Next payday. §148
MI Immediately. Immediately. §408.475(1)-(2)
MN Immediately. Next payday (or within 20 days if next payday is within 5 days). §§181.13(a), 181.14(a)
MS Not mentioned in statutes. Not mentioned in statutes. N/A
MO Immediately. Not mentioned in statutes. §290.110
MT Immediately. Within 15 days or next payday (whichever is earlier). §39-3-205(1)-(2)
NE Within 2 weeks or next payday (whichever is earlier). Within 2 weeks or next payday (whichever is earlier). §48-1230(4)(a)
NV Immediately. Within 7 days or next payday (whichever is later). §§608.020(1), 608.030
NH Within 72 hours. Next payday (or within 72 hours if one pay period’s notice is given). §275:44(I)-(II)
NJ Next payday. Next payday. §34:11-4.3
NM Immediately (no later than 5 days). Next payday. §§50-4-4(A), 50-4-5
NY Next payday. Next payday. §191(3)
NC Next payday. Next payday. §95-25.7
ND Next payday. Next payday. §34-14-03
OH Not mentioned in statutes. Not mentioned in statutes. N/A
OK Next payday. Next payday. §165.3(A)
OR Next workday. Within 5 days or next payday (whichever is earlier, or immediately if 48 hours’ notice is given). §652.140
PA Next payday. Next payday. §260.5(a)
RI Next payday. Next payday. §28-14-4(a)
SC Within 48 hours or next payday (no later than 30 days). Not mentioned in statutes. §41-10-50
SD Next payday. Next payday. §§60-11-10, 60-11-11
TN Within 21 days or next payday (whichever is later). Within 21 days or next payday (whichever is later). §50-2-103(g)
TX Within 6 days. Next payday. §61.014
UT Immediately (no later than 24 hours). Next payday. §34-28-5(1)-(2)
VT Within 72 hours. Next payday. §342(b)
VA Next payday. Next payday. §40.1-29(A)
WA At the end of the pay period. At the end of the pay period. §49.48.010(2)
WV Next payday. Next payday. §21-5-4(b)
WI Next payday (no later than 31 days). Next payday (no later than 31 days). §109.03(1)-(2)
WY Next payday. Next payday. §27-4-104(a)

Sample

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FINAL PAYCHECK ACKNOWLEDGMENT

PAYCHECK INFORMATION

I, [EMPLOYEE NAME], have received my final paycheck from [EMPLOYER NAME] on [MM/DD/YYYY]. The total amount of the paycheck is $[TOTAL AMOUNT].

The total paycheck amount represents:

Wages
[PAY PERIOD]: $[WAGES AMOUNT]

Accrued Vacation Pay
[VACATION TIME ACCRUED]: $[VACATION PAY AMOUNT]

Other
[OTHER PAY REASON]: $[OTHER PAY AMOUNT]
[OTHER PAY REASON]: $[OTHER PAY AMOUNT]
[OTHER PAY REASON]: $[OTHER PAY AMOUNT]

Deductions
[DEDUCTION REASON]: $[DEDUCTION AMOUNT]
[DEDUCTION REASON]: $[DEDUCTION AMOUNT]
[DEDUCTION REASON]: $[DEDUCTION AMOUNT]

Total:                                           $[TOTAL AMOUNT]

ACKNOWLEDGMENT

To the best of my knowledge, there is no additional money owed to me, [EMPLOYEE NAME], by [EMPLOYER NAME] at the present time.

Employee Signature:                                                               Date: ______________
Print Name:[EMPLOYEE NAME]

Employer Signature:                                                               Date: ______________
Print Name:[EMPLOYER NAME]

Sources

  1. §§ 60-11-10, 60-11-11
  2. § 11-4-405(b)