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Fillable Printable Form WH-347

Fillable Printable Form WH-347

Form WH-347

Form WH-347

U.S.DepartmentofLabor
PAYROLL
(ForContractor's Optional Use;See Instructions at www.dol.gov/whd/forms/wh347instr.htm)
Wage and Hour Division
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAMEOFCONTRACTOROR SUBCONTRACTOR
ADDRESS
OMBNo.: 1235-0008
Expires:02/28/2018
PAYROLLNO.FORWEEK ENDING
PROJECTAND LOCATION
PROJECTORCONTRACTNO.
(1)(2)(3)(4) DAYANDDATE(5)(6)(7)(9)
(8)
DEDUCTIONS
O
O
O
O
O
O
O
O
NAME AND INDIVIDUAL IDENTIFYING NUMBER
(e.g., LAST FOUR DIGITS OF SOCIALSECURITY
NUMBER) OFWORKER
NO. OF
WITHHOLDiNG
EXEMPTIONS
WORK
CLASSIFICATION
OT. ORST.
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OFPAY
GROSS
AMOUNT
EARNEDFICA
WITH-
HOLD
ING
TAXOTHER
TOTAL
DEDUCTIONS
NET
WAGES
PAID
FOR WEEK
S
S
S
S
S
S
S
S
Rev. Dec. 2008
Rev. Dec. 2008
While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R. §§ 3.3, 5.5(a). The Copeland Act
(40 U.S.C. § 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee during the preceding week." U.S. Department of Labor (DOL) regulations at
29 C.F.R. § 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project, accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer
or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this information review the information to determine that employees have received legally required wages and fringe benefits.
Public Burden Statement
We estimate that is will take an average of 55 minutes to complete this collection, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have
any comments regarding these estimates or any other aspect of this collection, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S3502, 200 Constitution Avenue, N.W.
Washington, D.C. 20210
(over)
Date
I,
(Name of Signatory Party)(Title)
do hereby state:
(1) That I pay or supervise the payment of the persons employed by
o
n
t
h
e
(Contractor or Subcontractor)
; that during the payroll period commencing on the
(Building or Work)
day of,,and ending theday of,,
all persons employed on said projecthavebeen paid t
he full weeklywages earned, that no rebates have
been or will be made either directly or indirectly to or on behalf of s
aid
fromthe full
(Contractor or Subcontractor)
weekly wages earned by anyperson and that no deductions havebeen made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part
3 (29 C.F.R.Subtitle A), issued bythe Secretary of Labor under the Copeland Act, as amended (48 Stat. 948,
63 Stat. 108, 72 Stat. 967; 76 St
at. 357; 40 U.S.C.§ 3145), and described below:
(2) That
any payrolls ot
herwise under thiscontractrequired tobe subm
itted for the aboveperiod are
correct and complete; that the wage ratesfor laborersor mechanics contained therein are not less than the
applicablewageratescontainedinany
wage determinationincorporated intothe contract; thatthe classifications
set forth therein for each laborer or mechanic conform with the work he performed.
(3) That anyapprentices employed in the aboveperiodaredulyregisteredina bonafide apprenticeship
programregis
tered witha State apprenticeshipagencyrecognizedbytheBureauof Apprenticeship and
Training, United States Department of Labor, or if no such recognized agency exists in a State, are registered
with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAI
D TO APPROVED PLANS,FUNDS,OR PROGRAMS
in addition to the basichourlywage ratespaid toeach laborer or mechaniclistedin
theabovereferencedpayroll,paymentsoffringe benefitsaslist
ed in the contract
haveb
eenorwill bemadetoappropriateprogramsforthe benefitofsuchemployees,
e
xceptasnoted in section 4(c)
below.
(b) WHERE FRINGE BENEFITS AR
E PAIDINCASH
Each laborer or mechaniclisted in the above referenced payroll hasbeen paid,
asindicated on the payroll,an amountnotlessthan the sumofthe applicable
basichourlywage rate plusthe amountofthe required fringe benefitsaslisted
in the contract,exceptasnoted in section 4(c) below.
(c) E
XCEPTIONS
REMARKS:
EXCEPTION(CRAFT)
EXPLANATION
NAMEAND TITLESIGNATURE
THE WILLFUL FALSIFICATION OFANY
OFTHE ABOVE STATEMENTS MAY SUBJECTTHE CONTRACTOR OR
SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE
31 OF THE UNITED STATES CODE.
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