Blank U.S. DoL PDF Form

Blank U.S. DoL PDF Form

The U.S. Department of Labor (DoL) form is a document used to collect important information regarding employment and labor practices. This form plays a crucial role in ensuring compliance with labor laws and protecting workers' rights. If you need to fill out the form, please click the button below.

The U.S. Department of Labor (DoL) form is a crucial document that plays a significant role in various labor-related processes, impacting both employers and employees. This form encompasses a range of essential information, including wage and hour compliance, workplace safety, and employee rights. It serves as a means for reporting violations, requesting information, or applying for benefits. Understanding the intricacies of this form is vital for navigating the complexities of labor laws and ensuring compliance with federal regulations. Employers must be aware of the specific requirements outlined in the form to avoid potential penalties, while employees should familiarize themselves with its content to protect their rights and entitlements. Timely and accurate completion of the DoL form can make a substantial difference in resolving disputes and fostering a fair work environment.

Document Sample

U.S. Department of Labor Davis-Bacon and Related Acts Weekly Certified Payroll Form

Wage and Hour Division

(For Contractor’s Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm)

 

Unless otherwise noted, the information requested is specific to the named project below.

 

 

Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.

SUBMISSION OF FINAL DBRA CERTIFIED PAYROLL FORM

PRIME CONTRACTOR

SUBCONTRACTOR

Rev. January 2025

OMB No.: 1235-0008

Expires: 01/31/2028

PROJECT NAME

PROJECT NO. or CONTRACT NO.

CERTIFIED PAYROLL NO.

PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS NAME

PROJECT LOCATION

WAGE DETERMINATION NO.

WEEK ENDING DATE

PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS ADDRESS

(1A)

(1B)

(1C)

(1D)

(1E)

 

(2)

 

(3)

 

 

(4)

(5)

(6A)

(6B)

(6C)

(7A)

(7B)

 

 

(8)

 

 

NO.ENTRYWORKER

NAMELASTWORKER

FIRSTWORKER NAME

MIDDLEWORKER INITIAL

WORKER NO.IDENTIFYING

JOURNEYWORKER(J)

REGISTERD(RA)

APPRENTICE

LABOR CLASSIFICATION

TIMESTRAIGHT=ST

OVERTIME=OT

(TOP) DAYS OF WORK WEEK

HOURSTOTAL WEEKFORWORKED

RATEWAGEHOURLY ANDSTFORPAIDOT

FRINGETOTAL CREDITBENEFIT

LIEUINPAYMENTOF BENEFITSFRINGE

EARNEDAMTGROSS

EARNEDAMTGROSS WORKALLFOR

DEDUCTIONS FOR ALL WORK

(BOTTOM) DATES

-WITHTAX HOLDINGS

FICA

(MUSTOTHER

SEESPECIFY, INSTRUCTIONS)

TOTAL DEDUCTIONS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOURS WORKED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EACH DAY

 

 

 

 

 

 

 

 

 

 

 

(9)

FOR ALL WORK

NET PAY TO WORKER

ST

OT

ST

OT

ST

OT

ST

OT

ST

OT

ST

OT

ST

OT

ST

OT

While use of Form WH-347 itself is optional, covered contractors and subcontractors performing work on Federal or federally assisted construction contracts are required by the DBRA regulations and the contract clauses to submit payroll information on a weekly basis. The Copeland Act (40 U.S.C. § 3145) requires contractors and subcontractors performing work on Federal or federally financed construction contracts to, on a weekly basis, “furnish a statement on the wages paid each employee during the prior week.” U.S. Department of Labor (DOL) Regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors and subcontractors to submit weekly certified payrolls to the appropriate Federal agency if the agency is a party to the contract (or, if the agency is not such a party, to the applicant, sponsor, owner, or other entity, as the case may be, that maintains such records, for transmission to the Federal agency). Each certified payroll must be accompanied by a signed “Statement of Compliance” (e.g., page 2 of the WH-347 or another document with identical wording) indicating that the certified payrolls are accurate and complete, and that each laborer or mechanic has been paid not less than the required Davis-Bacon prevailing wage rate(s) (including any fringe benefits) for the work performed. DOL and contracting agencies receiving this information review the information to determine whether workers have received legally required wages and fringe benefits.

Public Burden Statement

We estimate that it 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)

PROJECT NAME

PROJECT NO. or CONTRACT NO.

PAYROLL NO.

PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS NAME

PROJECT LOCATION

 

WEEK ENDING DATE

CERTIFYING OFFICIAL’s NAME AND TITLE

I paid or supervised the payment of the laborers or mechanics working on the above project during the stated time period. I certify the following:

The payroll information submitted with this statement is correct and complete for the above project during the above period, and the wage and fringe benefit rates paid to the workers,

including credit taken for the reasonably anticipated costs of a bona fide fringe benefit plan, fund or program, are not less than the applicable wage and fringe benefits rates for the classification(s) of work actually performed, as specified in the wage determination(s) incorporated into the contract.

All regular payrolls and all other basic records that the contractor is required to maintain for this payroll period are complete and accurate and will be made available upon request from the

agency or the Department of Labor.

The classifications reported for each laborer or mechanic are the classification(s) of work that each worker actually performed.

Any workers paid as apprentices during the above period are duly registered in a bona fide apprenticeship program registered with the Office of Apprenticeship, Employment and Training

Administration, United States Department of Labor (“OA”), or a State Apprenticeship Agency (“SAA”) recognized by Department of Labor. I have verified the registered apprenticeship program information provided below as accurate and applicable to any apprentices identified on page 1 of this form.

APPRENTICESHIP PROGRAM NAME

 

REGISTERED

NAME OF LABOR CLASSIFICATION

 

 

 

OA

 

SAA

 

 

 

 

 

OA

 

SAA

 

 

 

 

 

OA

 

SAA

 

 

 

Fringe benefits have been paid in cash and/or to bona fide fringe benefit plans, funds, or programs. Where the contractor is claiming an hourly credit for their contributions to or reasonably

anticipated costs of a bona fide fringe benefit plan, fund, or program, provide plan information and the hourly credit claimed for each worker listed on the previous page of this form.

HOURLY CREDIT FOR FRINGE BENEFITS

If an amount is listed in (6B) on the first page of this certified payroll form, enter the hourly credit claimed under each plan name, type and number for each worker and check whether the plan is funded or unfunded.

 

 

 

FB NAME

 

 

 

FB NAME

 

 

 

FB NAME

 

 

 

FB NAME

 

 

 

FB NAME

 

 

 

FB NAME

 

 

 

 

TOTAL

 

 

 

FB TYPE

 

 

 

FB TYPE

 

 

 

FB TYPE

 

 

 

FB TYPE

 

 

 

FB TYPE

 

 

 

FB TYPE

 

 

 

 

NAME OF WORKER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOURLY

 

 

PLAN NO.

 

 

 

PLAN NO.

 

 

 

PLAN NO.

 

 

 

PLAN NO.

 

 

 

PLAN NO.

 

 

 

PLAN NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CREDIT

 

Funded

Unfunded

Funded

Unfunded

Funded

Unfunded

Funded

Unfunded

Funded

Unfunded

Funded

Unfunded

 

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

$

 

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hourly Credit

$

Hrly Credit

$

$

All workers on the project have been paid the full weekly wages earned, and no rebates or deductions have been or will be made either directly or indirectly, other than permissible

 

deductions as defined in 29 CFR part 3.

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL REMARKS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF CERTIFYING OFFICIAL

 

 

DATE

 

 

TELEPHONE NUMBER

 

 

EMAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

( __ __ __ ) __ __ __ – __ __ __ __

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION (SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31 OF THE UNITED STATES CODE), AS WELL AS DEBARMENT FROM FUTURE FEDERAL AND FEDERALLY-ASSISTED CONTRACTS. INFORMATION REPORTED IN CERTIFIED PAYROLLS MAY BE SUBJECT TO DISCLOSURE IN RESPONSE TO A FREEDOM OF INFORMATION ACT REQUEST.

File Specifics

Fact Name Description
Purpose The U.S. Department of Labor (DoL) form is used for various labor-related applications, including wage claims and workplace safety reports.
Types of Forms There are multiple types of forms, such as the WH-4 for wage claims and the OSHA forms for safety complaints.
Submission Method Forms can typically be submitted online, by mail, or in person, depending on the specific form and its requirements.
State-Specific Forms Some states have their own forms that align with federal regulations but may include additional state-specific requirements.
Governing Laws State-specific forms are governed by various laws, including state labor codes and regulations, which can differ significantly.
Confidentiality Information submitted on these forms is generally kept confidential, protecting the privacy of individuals involved.
Filing Deadlines Each form may have its own filing deadline, which is crucial to ensure timely processing of claims or reports.
Assistance The DoL provides resources and guidance for individuals filling out forms, making the process more accessible.
Impact Accurate completion of these forms can significantly affect workplace rights and protections for employees.

How to Use U.S. DoL

Completing the U.S. Department of Labor (DoL) form is an important step in the process you are undertaking. After filling out the form, you will need to review it carefully and submit it according to the instructions provided. Ensuring accuracy and completeness will help facilitate the next steps in your application or request.

  1. Obtain the correct form from the U.S. Department of Labor's website or your local office.
  2. Read the instructions provided with the form to understand the requirements.
  3. Begin filling out the form by entering your personal information, such as your name, address, and contact details.
  4. Provide any necessary identification numbers, like your Social Security number or employer identification number.
  5. Complete the specific sections of the form that apply to your situation, ensuring all required fields are filled out.
  6. If applicable, include any supporting documents or additional information as requested.
  7. Review your entries for accuracy and completeness. Double-check all information before finalizing the form.
  8. Sign and date the form where indicated.
  9. Make a copy of the completed form for your records.
  10. Submit the form according to the instructions, whether by mail, online, or in person.

Your Questions, Answered

What is the U.S. Department of Labor (DoL) form?

The U.S. Department of Labor (DoL) form is a document used for various purposes related to labor regulations and compliance. These forms can be required for reporting workplace injuries, filing wage claims, or submitting information about labor practices. Different forms serve different functions, so it is important to identify the specific form you need based on your situation.

Who needs to fill out a DoL form?

Individuals, employers, and organizations may need to fill out a DoL form. For example:

  • Employees may need to report workplace injuries or file wage claims.
  • Employers might be required to submit forms related to labor standards, safety regulations, or employee benefits.
  • Organizations may need to provide information for compliance with labor laws.

Identifying your role will help determine which form is applicable to you.

How do I obtain a DoL form?

You can obtain a U.S. DoL form in several ways:

  1. Visit the official Department of Labor website, where many forms are available for download.
  2. Contact your local DoL office for assistance in obtaining the necessary forms.
  3. Check with your employer, as they may have the forms readily available for employees.

Make sure to download or request the correct form for your specific needs.

What happens after I submit a DoL form?

After submitting a DoL form, you can expect a few different outcomes depending on the type of form and the information provided. Typically, the following steps occur:

  • Your submission will be reviewed by the appropriate department or agency.
  • You may receive confirmation of receipt, along with any further instructions if needed.
  • In some cases, an investigation or follow-up may occur, especially if the form pertains to a complaint or claim.

It is important to keep a copy of your submission for your records.

Are there deadlines for submitting DoL forms?

Yes, there are often deadlines associated with submitting DoL forms, and these can vary based on the specific form and the situation. For instance:

  • Wage claims may need to be filed within a certain time frame after the issue occurs.
  • Reports of workplace injuries may have specific deadlines to ensure compliance with safety regulations.

To avoid complications, it is advisable to check the specific requirements for the form you are completing.

Common mistakes

  1. Incomplete Information: Many people forget to fill out all required fields. Leaving sections blank can delay processing. Always double-check that every necessary part is filled in.

  2. Incorrect Dates: Entering the wrong dates can lead to confusion. Ensure that all dates are accurate and formatted correctly. This includes start and end dates for employment.

  3. Missing Signatures: A signature is often required to validate the form. Failing to sign can result in rejection. Make sure to sign and date the form before submission.

  4. Using Unclear Language: Vague descriptions can cause misunderstandings. Be specific and clear about your situation. This helps the reviewer understand your case better.

Documents used along the form

When dealing with employment-related matters, several forms and documents may be required alongside the U.S. Department of Labor (DoL) form. Each of these documents serves a specific purpose and can help ensure compliance with labor laws and regulations. Below is a list of commonly used forms and documents.

  • Employment Application: This document collects personal information, work history, and qualifications from job applicants. It helps employers assess candidates for available positions.
  • W-4 Form: Employees complete this form to indicate their tax withholding preferences. It is essential for employers to accurately withhold federal income tax from employee paychecks.
  • Form I-9: This form verifies an employee's identity and eligibility to work in the United States. Employers must complete it for each new hire within three days of employment.
  • Employee Handbook: This document outlines company policies, procedures, and employee rights. It serves as a guide for employees regarding workplace expectations and benefits.
  • Pay Stubs: Issued with each paycheck, pay stubs detail an employee's earnings, deductions, and net pay. They provide transparency regarding compensation and tax withholdings.
  • Separation Agreement: This document is used when an employee leaves a company, outlining the terms of the separation. It may include severance pay, confidentiality clauses, and non-compete agreements.
  • Time Sheets: Employees track their hours worked on this document. It is essential for calculating wages and ensuring compliance with labor regulations regarding overtime.

These forms and documents are integral to managing employment relationships and ensuring compliance with federal and state laws. Understanding their purpose can help streamline processes and protect both employees and employers.

Similar forms

The U.S. Department of Labor (DoL) form can be compared to the IRS Form W-2. Both documents serve as official records of income and employment. The W-2 is issued by employers to report wages paid to employees and the taxes withheld. Similarly, the DoL form may be used to document employment status or wage information for workers, ensuring compliance with labor laws.

Another similar document is the Form I-9, which is used for verifying the identity and employment authorization of individuals hired for employment in the United States. Like the DoL form, the Form I-9 is crucial for maintaining compliance with federal regulations. Both forms require accurate information about the employee and serve to protect workers' rights.

The Employment Eligibility Verification (EEV) form is also comparable. This form is used by employers to verify the eligibility of their employees to work in the U.S. The DoL form may contain similar information, focusing on the legal status of workers and ensuring they are entitled to employment under labor laws.

The Fair Labor Standards Act (FLSA) compliance form is another relevant document. This form outlines minimum wage and overtime requirements. Like the DoL form, it is essential for employers to ensure they are adhering to federal labor standards, protecting employees from unfair pay practices.

Additionally, the Occupational Safety and Health Administration (OSHA) forms share similarities. These documents are used to report workplace injuries and illnesses. Both the OSHA forms and the DoL form aim to promote safe working conditions and protect workers' rights within the labor force.

The Family and Medical Leave Act (FMLA) certification form is also similar. This document is used to request leave for family or medical reasons. The DoL form may be involved in ensuring that employees understand their rights under the FMLA, emphasizing the importance of job protection during critical life events.

The Unemployment Insurance (UI) claim form is another document that serves a similar purpose. It is used by individuals seeking unemployment benefits. Like the DoL form, the UI claim form helps to provide financial support to workers who have lost their jobs, ensuring they have access to necessary resources during difficult times.

The Employee Retirement Income Security Act (ERISA) disclosure form is also comparable. This document provides information about employee benefits and retirement plans. Both the DoL form and the ERISA disclosure are essential for informing employees of their rights and benefits, promoting transparency in the workplace.

The Worker Adjustment and Retraining Notification (WARN) Act notice is another relevant document. This notice informs employees about mass layoffs or plant closings. The DoL form may play a role in ensuring that workers are aware of their rights and the protections available to them during such transitions.

Lastly, the Equal Employment Opportunity Commission (EEOC) charge form is similar in that it addresses workplace discrimination. This form allows individuals to report discrimination based on various factors. Like the DoL form, it is vital for protecting employees' rights and ensuring a fair and equitable work environment.

Dos and Don'ts

When filling out the U.S. Department of Labor (DoL) form, it’s important to follow certain guidelines to ensure your submission is accurate and complete. Here are ten things you should and shouldn’t do:

  • Do read the instructions carefully before starting.
  • Do fill out all required fields completely.
  • Do double-check your information for accuracy.
  • Do keep a copy of the completed form for your records.
  • Do submit your form before the deadline.
  • Don't leave any required fields blank.
  • Don't use abbreviations unless specified.
  • Don't provide false information.
  • Don't forget to sign and date the form.
  • Don't ignore any additional documentation requirements.

Following these guidelines will help ensure your form is processed smoothly. If you have questions, consider reaching out for assistance.

Misconceptions

There are several misconceptions regarding the U.S. Department of Labor (DoL) forms. Understanding these can help individuals navigate the process more effectively.

  • All DoL forms are the same. This is not true. The U.S. DoL has various forms tailored to different purposes, such as wage complaints, labor standards, and workplace safety. Each form serves a specific function and requires different information.
  • Filing a DoL form guarantees a quick resolution. Many believe that submitting a form will lead to an immediate outcome. However, the process can take time. Investigations and reviews are often necessary before any action is taken.
  • DoL forms are only for employees. While many forms are designed for workers, employers also need to use specific forms to comply with labor laws. Both parties may need to submit forms depending on the situation.
  • Once a form is submitted, it cannot be changed. This misconception can lead to frustration. In many cases, individuals can amend or withdraw their submissions if necessary, but they must follow the proper procedures to do so.

Clarifying these misconceptions can help individuals and employers better understand their rights and responsibilities under U.S. labor laws.

Key takeaways

Filling out and using the U.S. Department of Labor (DoL) form can seem daunting, but understanding a few key points can make the process smoother. Here are some essential takeaways:

  • Know the Purpose: Each DoL form serves a specific purpose, whether it's for wage claims, workplace safety, or employment statistics. Understanding the form's intent is crucial.
  • Gather Necessary Information: Before starting, collect all required information, such as personal details, employment history, and any relevant documentation.
  • Be Accurate: Fill out the form with precise information. Inaccuracies can lead to delays or denials of your claim or request.
  • Follow Instructions: Each form comes with detailed instructions. Read them carefully to ensure you complete the form correctly.
  • Check for Deadlines: Many forms have strict submission deadlines. Be aware of these timelines to avoid missing important opportunities.
  • Keep Copies: Always make copies of your completed forms and any supporting documents before submission. This can be helpful for future reference.
  • Seek Assistance if Needed: If you find the form confusing, don’t hesitate to seek help from a legal expert or a relevant organization. They can provide guidance tailored to your situation.

By keeping these points in mind, individuals can navigate the complexities of the U.S. DoL forms more effectively and confidently.