U.S. Department of Labor
Wage and Hour Division
PAYROLL
For contractor's optional use; see instructions at dol.gov/agencies/whd/forms/wh347
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
NAME OF CONTRACTOR OR SUBCONTRACTOR
ADDRESS
OMB No. 1235-0008
Expires 09/30/2026
PAYROLL NO. FOR WEEK ENDING
PROJECT AND LOCATION
PROJECT OR CONTRACT NO.
(1) (2) (3) (4) DAY AND DATE (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 SOCIAL SECURITY
NUMBER) OF WORKER
NO. OF
W ITHHOLDiNG
EXEMPTIONS
WORK
CLASSIFICATION
OT. OR ST.
HOURS WORKED EACH DAY
TOTAL
HOURS
RATE
OF PAY
GROSS
AMOUNT
EARNED FICA
WITH-
HOLDING
TAX OTHER
TOTAL
DEDUCTIONS
NET
WAGES
PA
ID
FOR WEEK
S
S
S
S
S
S
S
S
Rev. Dec. 2008
Revised December 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 s
upervise the payment of the persons employ
ed by
o
n
t
h
e
(Contractor or Subcontractor)
; that during the payroll period commencing on the
(Building or Work)
day of , , and ending the day of , ,
all persons employed on said project have been paid the f u
ll weekly wages earned, that no rebates have
been or will be made either directly or indirectly to or on behalf of said
from the full
(Contractor or Subcontractor)
weekly wages earned by any person and that no deductions have been 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 by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948,
63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C
. § 3145), and described below:
(2) That
any
payrolls otherwise under t
his contract required to be submitted fo
r the above period are
correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the
applicable wage rates contained in any wage dete
rmination incorporated into the contract; that the classifications
set forth therein for each laborer or mechanic conform with the work he performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship
program registered wi
th a State apprenticeship agency recognized by the Bureau of 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) T
hat
:
(a)
W
HERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAM
S
−
in addition to the basic hourly wage rates paid to each laborer or mechanic listed in
t
he above referenced payroll, payments of fringe benefits as listed in the c
ontract
ha
ve been o
r will be made to appropriate programs for the benefit of such employees,
e
xcept as noted in section 4(c) below
.
(b)
W
HERE FRINGE BENEFITS AR
E PAID I
N CASH
−
Each laborer or mechanic listed in the above referenced payroll has been paid,
as indi
cated on the payroll, an amount not less than the sum of the applic
able
ba
sic hourly wage rate plus the amount of the required fringe benefits as list
ed
in the contract, except as noted in section 4(c) below.
(
c
) E
X
CEPTION
S
REMARKS:
EXCEPTION (CRAFT) EXPLANATION
NAME AND TITLE SIGNATURE
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.
