U.S. Department of Labor PAYROLL ba
Wage and Hour Division ‘ ‘ . . :
g (For Contractor's Optional Use; See Instructions at www.dol.gov/iwhd/forms/wh347instr.htm)} ULS, Wage and Hour Division
Persons are not required to respond to the collection of information unless it displays a currently valid OMB contro! number. Rev. Dec. 2008
NAME OF CONTRACTOR [ ] OR SUBCONTRACTOR [7] ADDRESS OMB No,: 1235-0008
Expires: 02/28/2018
PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO.
(4) (2) (3) (4) DAY AND DATE (5) (8) {7) (3)
(8)
g 2 5 DEDUCTIONS
86 x NET
NAME AND INOIWVIDUAL IDENTIFYING NUMBER u¥ E o GROSS WITH: WAGES
(6.g., LAST FOUR DIGITS OF SOCIAL SECURITY SE a WORK 6 TOTAL RATE AMOUNT HOLDING TOTAL PAID
NUMBER) OF WORKER ge CLASSIFICATION HOURS WORKED EACH DA IHOURS| OF PAY EARNED FICA TAX OTHER _|DEDUCTIONS] FOR WEEK
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While completian of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors parforming work on Federally financed or assisted construction contracts to respond to the information collection contained fn 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 2 statement with respect to the wages paid each employee during the praceding weak,” 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 "Sti t of Compliance" i ing that the payrolls are correct and complete and that each laborer
or mechanic has deen paid not lass 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, gatharing and maintaining the data needed, and completing and ravi g the collaction of infc tion, 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 $3502, 200 Constitution Avanue, N.W.
Washington, D.C. 20210
(over)
