Data Dispute Form

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Employee Data Dispute

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EMPLOYEE DATA DISPUTE

To dispute information on your Employment Data Report (EDR), simply complete and submit the necessary information. Please note the dispute process may take up to 30 days for completion.

Please note asterisks indicate fields required for submission. For questions, please contact The Work Number Employee Service Center at 1-866-222-5880 or 1-800-424-0253 for TTY-hearing impaired assistance Monday through Friday, from 9:00 a.m. to 8:00 p.m. ET.

Social Security Number*

First Name*

Last Name*

Suffix

Street Address (Residential)*

City*

State*

Zip Code*

Phone Number*

Email Address*

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Employee Data Dispute

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Disputed Information

Please enter your Employer Name or Employer Code.*

Please select your main cause for completing this Employee Data Dispute. Only one option may be selected.*

Please enter all of the information you would like to dispute in the optional fields below.

Employment Information

Original Hire Date (MM/DD/YYYY)

Most Recent Hire Date (MM/DD/YYYY)

Term Date (MM/DD/YYYY)

Employment Status

Job Title

Total Time With Employer

Pay Information

Rate of Pay

Pay Period Details (i.e., pay date, hours worked, gross, net earnings)

Average Hours Per Pay Period

Personal Information

Married and/or Maiden Names

Legally Changed Name

Aliases

Please enter any additional comments regarding the information listed above.

If you have additional information you would like to dispute regarding pay, please check the box below. Please note fields marked with asterisks are required.

I have additional information to add.

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