Davis-Bacon and Related Acts Weekly Certified Payroll Form (Form WH-347) Instructions

Enter the registered apprenticeship program name for the top entry in this apprenticeship section. Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Enter the labor classification or job title associated with the top apprenticeship entry (the work actually performed).

Enter the registered apprenticeship program name for the first listed apprentice row in this section. Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program listed on the first apprenticeship-program row is registered (general yes/no) for the program named on that row.

Enter the labor classification or job title for the first listed apprentice row (the work actually performed). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program on the first row is registered with the federal Office of Apprenticeship (OA). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program on the first row is registered with a State Apprenticeship Agency (SAA). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Enter the registered apprenticeship program name for the second listed apprentice row in this section. Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program listed on the second apprenticeship-program row is registered (general yes/no) for the program named on that row. Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Enter the labor classification or job title for the second listed apprentice row (the work actually performed). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program on the second row is registered with the federal Office of Apprenticeship (OA). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program on the second row is registered with a State Apprenticeship Agency (SAA). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Enter the registered apprenticeship program name for the third listed apprentice row in this section. Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Enter the labor classification or job title for the third listed apprentice row (the work actually performed). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program on the third apprenticeship-program row is registered with the federal Office of Apprenticeship (OA). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Check this box when the apprenticeship program on the third apprenticeship-program row is registered with a State Apprenticeship Agency (SAA). Fill only if 'Apprentices are registered in a bona fide apprenticeship program and verified' is 'Yes'.

Enter the text (for example initials, signature, or 'Yes') to indicate you certify that you paid or supervised payment of the laborers/mechanics and that the payroll information submitted for the stated period is correct and complete.

Check this box to certify that the payroll information you submitted for the project and period is correct and complete and that the wage and fringe benefit rates paid meet or exceed the applicable rates.

Check this box to confirm that all regular payrolls and other basic records required for this payroll period are complete, accurate, and will be made available upon request by the agency or the Department of Labor.

Enter the text (for example initials, signature, or 'Yes') to indicate you certify that the classifications reported for each laborer or mechanic accurately reflect the work that each worker actually performed.

Check this box to certify that the classifications reported for each laborer or mechanic are the actual classification(s) of work each worker performed.

Check this box to verify that any workers paid as apprentices during the period are duly registered in a bona fide apprenticeship program (OA or SAA) recognized by the Department of Labor and that you have verified the program information for the apprentices listed on the form.

Check this box when fringe benefits were paid in cash and/or to bona fide fringe benefit plans, funds, or programs for the reporting period and you will provide the required plan information and hourly credit claimed for each worker.

Check this box when the fringe benefit plan shown in the first plan column is a funded plan used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the first plan column is an unfunded arrangement (cash or otherwise not maintained as a funded plan) used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the second plan column is a funded plan used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the second plan column is an unfunded arrangement used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the third plan column is a funded plan used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the fifth plan column is a funded plan used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the third plan column is an unfunded arrangement used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the fourth plan column is a funded plan used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the fourth plan column is an unfunded arrangement used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the fifth plan column is an unfunded arrangement used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the sixth plan column is a funded plan used to calculate the hourly credit for the worker(s) in the row.

Check this box when the fringe benefit plan shown in the sixth plan column is an unfunded arrangement used to calculate the hourly credit for the worker(s) in the row.

Enter the hourly credit claimed for worker 3 under fringe benefit plan 1.

Enter the hourly credit claimed for worker 3 under fringe benefit plan 2. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 3 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 3 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 3 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 3 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 3 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 10 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 10 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 10 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 10 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 10 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 10 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 10 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 23 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 23 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 23 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 23 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 23 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 23 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 23 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 37 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 37 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 37 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 37 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 37 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 37 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 37 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 50 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 50 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 50 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 50 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 50 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 50 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 50 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 63 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 63 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 63 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 63 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 63 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 63 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 63 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 71 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 71 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 71 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 71 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 71 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 71 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 71 across all listed fringe benefit plans.

Enter the hourly credit claimed for worker 79 under fringe benefit plan 1. Fill only if 'Hourly Credit Plan 1 — Unfunded' is 'Yes'.

Enter the hourly credit claimed for worker 79 under fringe benefit plan 2.

Enter the hourly credit claimed for worker 79 under fringe benefit plan 3.

Enter the hourly credit claimed for worker 79 under fringe benefit plan 4.

Enter the hourly credit claimed for worker 79 under fringe benefit plan 5.

Enter the hourly credit claimed for worker 79 under fringe benefit plan 6.

Enter the total hourly credit claimed for worker 79 across all listed fringe benefit plans.

Enter the full name of the fringe benefit plan for Plan 1 as shown on payroll or benefits records.

Enter the full name of the fringe benefit plan for Plan 2 as shown on payroll or benefits records.

Enter the full name of the fringe benefit plan for Plan 3 as shown on payroll or benefits records.

Enter the full name of the fringe benefit plan for Plan 4 as shown on payroll or benefits records.

Enter the full name of the fringe benefit plan for Plan 5 as shown on payroll or benefits records.

Enter the full name of the fringe benefit plan for Plan 6 as shown on payroll or benefits records.

Enter the identifying plan number or code for the fringe benefit plan associated with Plan 1.

Enter the identifying plan number or code for the fringe benefit plan associated with Plan 2.

Enter the identifying plan number or code for the fringe benefit plan associated with Plan 3.

Enter the identifying plan number or code for the fringe benefit plan associated with Plan 4.

Enter the identifying plan number or code for the fringe benefit plan associated with Plan 5.

Enter the identifying plan number or code for the fringe benefit plan associated with Plan 6.

Check this box if all workers on the project have been paid the full weekly wages earned for this payroll period and no rebates or deductions (other than those permitted by 29 CFR part 3) have been or will be made, either directly or indirectly.

Enter any brief additional comments or clarifications related to payroll confirmation, deductions, or compliance for the payroll period.

Enter further details or continuation of remarks about payroll practices, fringe benefits, apprenticeships, or other relevant notes for this payroll statement.

Provide any extended narrative, explanations, or supplementary information that does not fit in the prior remark lines and is relevant to the payroll certification.

Check this box when the top-listed worker on Payroll Table Row 1 worked straight-time (ST) hours on Day 1 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked straight-time (ST) hours on Day 2 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked straight-time (ST) hours on Day 3 of the payroll week.

Enter the worker's first (given) name for this payroll row.

Enter the worker's middle initial for this payroll row.

Enter the worker's job classification or trade (for example, Carpenter, Laborer) for this payroll row.

Enter the total number of hours this worker worked for the week.

Enter the hourly wage rate paid to this worker for straight time and overtime.

Enter the amount of fringe benefits the employer paid on behalf of this worker for the week.

Enter any payments made to the worker in lieu of fringe benefits for the week.

Enter the gross wages earned by the worker for the work shown on this payroll line.

Enter the worker's gross wages for all work performed during the week.

Enter the total tax withholdings deducted from the worker's pay for the week.

Enter the FICA (Social Security/Medicare) amounts withheld from the worker's pay for the week.

Enter any other deductions withheld from the worker's pay for the week and specify them per the form instructions.

Check this box to indicate that this row corresponds to the listed Worker Entry Number (the top worker entry on the payroll table).

Enter the payroll entry number assigned to this worker for this payroll (row identifier).

Enter the worker's last (family) name for this payroll row.

Enter the employer-assigned identifying number for the worker (for example, badge, payroll, or ID number).

Enter the total fringe benefit credits applied to this worker for the week.

Enter the net pay actually paid to the worker for all work after all deductions for the week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 1 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 2 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 3 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 4 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 5 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 6 of the payroll week.

Check this box when the top-listed worker on Payroll Table Row 1 worked overtime (OT) hours on Day 7 of the payroll week.

Enter the hourly wage rate paid to the worker for straight time and overtime on row 2.

Enter the sequential payroll entry number assigned to this worker on row 2.

Enter the worker's last (family) name for the second (Row 2) payroll entry.

Enter the worker's middle initial (single letter) for the second (Row 2) payroll entry.

Enter the worker’s classification indicator (for example 'J' for journeyworker or 'A'/'R' for registered apprentice) for row 2.

Enter the total straight‑time hours this worker worked during the payroll workweek for row 2.

Enter the total fringe benefit credit amount claimed for this worker on row 2.

Enter the total amount actually paid for fringe benefits on behalf of this worker for row 2.

Enter any cash payments made to the worker in lieu of fringe benefits for row 2.

Enter the gross earnings the worker earned for the contract work covered by this payroll row (row 2).

Enter the worker's total gross earnings for all work performed during the payroll period for row 2.

Enter the total federal/state tax withholdings deducted from this worker's pay for row 2.

Enter the total FICA (Social Security/Medicare) deductions withheld from the worker on row 2.

Enter any other deductions withheld from this worker's pay for row 2 and specify the deduction type elsewhere as required.

Enter the net pay amount the worker received for all work after deductions for row 2.

Enter the worker's first (given) name for the second (Row 2) payroll entry.

Enter the employer-assigned identifying number for this worker (badge, payroll ID, or last digits of SSN) as used on payroll.

Check this box when the second listed worker worked straight (ST) hours on the first day of the pay week shown and you are recording their hours for that day.

Check this box when the second listed worker worked straight (ST) hours on the second day of the pay week shown and you are recording their hours for that day.

Check this box when the second listed worker worked straight (ST) hours on the third day of the pay week shown and you are recording their hours for that day.

Check this box when the second listed worker worked straight (ST) hours on the fourth day of the pay week shown and you are recording their hours for that day.

Check this box when the second listed worker worked straight (ST) hours on the fifth day of the pay week shown and you are recording their hours for that day.

Check this box when the second listed worker worked straight (ST) hours on the sixth day of the pay week shown and you are recording their hours for that day.

Check this box when the second listed worker worked straight (ST) hours on the seventh day of the pay week shown and you are recording their hours for that day.

Enter the payroll entry number assigned to the third worker on this row.

Enter the third worker's last name (family/surname).

Enter the third worker's first (given) name.

Enter the third worker's middle initial, if applicable.

Enter the identifying number used by the employer for the third worker (for example, employee ID or last four of SSN).

Enter the status code for the third worker indicating Journeyworker or Registered Apprentice as applicable.

Enter the trade or labor classification for the third worker (for example, Carpenter, Laborer, Electrician).

Total straight-time and overtime hours the third worker worked during the week, summed across all days.

Hourly wage rate paid to the third worker for straight-time and overtime work.

Total fringe benefit credit to be paid on behalf of the third worker.

Amount paid to the third worker in lieu of fringe benefits.

Gross wages earned by the third worker for the work covered on this payroll row.

Total gross earnings for the third worker for all work performed during the payroll period.

Total federal, state, and local taxes withheld from the third worker's pay for this payroll period.

Total FICA (Social Security and Medicare) amounts withheld from the third worker's pay.

Any other miscellaneous deductions withheld from the third worker's pay that must be identified separately.

Sum of all deductions withheld from the third worker's gross pay for this payroll period.

Net amount paid to the third worker after all deductions for the payroll period.

Check this box when the third worker worked straight time (ST) on Day 1 (the leftmost day) of the workweek shown in the 'Hours Worked Each Day' grid.

Check this box when the third worker worked straight time (ST) on Day 2 of the workweek shown in the 'Hours Worked Each Day' grid.

Check this box when the third worker worked straight time (ST) on Day 3 of the workweek shown in the 'Hours Worked Each Day' grid.

Check this box when the third worker worked straight time (ST) on Day 4 of the workweek shown in the 'Hours Worked Each Day' grid.

Check this box when the third worker worked straight time (ST) on Day 5 of the workweek shown in the 'Hours Worked Each Day' grid.

Check this box when the third worker worked straight time (ST) on Day 6 of the workweek shown in the 'Hours Worked Each Day' grid.

Enter the full business address of the prime contractor or subcontractor associated with this payroll row. Fill only if 'Prime Contractor', 'Subcontractor' is 'Yes' (any).

Enter the payroll worker entry number assigned to this worker for this row.

Enter the worker's last (family) name exactly as it appears on payroll records.

Enter the worker's first (given) name.

Enter the worker's middle initial (single letter) or leave blank if none.

Enter the employer-assigned identification number for the worker (payroll ID, badge number, or other identifier).

Enter the worker's skill/apprenticeship designation or code (for example 'J' for journeyman or 'A' for apprentice) if applicable.

Enter the worker's labor classification or trade (for example, 'Carpenter', 'Laborer', or trade code).

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 1 of the work week.

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 2 of the work week.

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 3 of the work week.

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 4 of the work week.

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 5 of the work week.

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 6 of the work week.

Check this box when recording the fourth worker's straight-time (ST) hours worked on Day 7 of the work week.

Enter the total hours the worker worked during the week.

Enter the hourly wage rate paid to the worker for straight time and overtime.

Enter the total fringe benefit credit amount attributable to the worker.

Enter any cash payment made to the worker in lieu of fringe benefits.

Enter the gross earnings the worker earned on this payroll for the job before deductions.

Enter the worker's total gross earnings for all work during the pay period.

Enter total federal/state income tax withheld from the worker's pay for this pay period.

Enter total FICA (Social Security and Medicare) taxes withheld from the worker.

Enter any other deductions taken from the worker's pay and specify the deduction type on the form.

Enter the sum of all deductions withheld from the worker's gross pay.

Enter the worker's net (take-home) pay after all deductions for the pay period.

If this worker's information continues on a second line, enter the continuation worker entry number here; otherwise leave blank.

If using a continuation line, enter the worker's identifying number (payroll/ID) on that secondary line; otherwise leave blank.

Check this box when recording additional straight-time (ST) hours for the fourth worker on the continuation/next ST row for Day 1.

Check this box when recording additional straight-time (ST) hours for the fourth worker on the continuation/next ST row for Day 2.

Check this box when recording additional straight-time (ST) hours for the fourth worker on the continuation/next ST row for Day 3.

Check this box to indicate that this row is the fifth worker entry on the payroll (use when entering the fifth worker's information).

Check this box when the fifth worker worked straight‑time hours on Day 1 of the work week.

Check this box when the fifth worker worked straight‑time hours on Day 2 of the work week.

Check this box when the fifth worker worked straight‑time hours on Day 3 of the work week.

Check this box when the fifth worker worked straight‑time hours on Day 4 of the work week.

Check this box when the fifth worker worked straight‑time hours on Day 5 of the work week.

Check this box when the fifth worker worked straight‑time hours on Day 6 of the work week.

Check this box when the fifth worker worked straight‑time hours on Day 7 of the work week.

Enter a short code or brief note used to annotate the hourly wage entry for this worker, if applicable.

Enter the worker's legal last name (surname) for this payroll row.

Enter the worker's journeyworker or registered apprentice designation or code (e.g., 'JW', 'RA') if applicable.

Enter the worker's trade or labor classification (for example: Carpenter, Electrician, Laborer) that applies to the work performed.

Check this box when recording the fifth worker's total straight‑time hours for the entire work week (the sum of Day 1–Day 7).

Check this box when the corresponding adjacent hours/summary field for the fifth worker is used to record hours related to this ST row.

Check this box when the corresponding adjacent hours/summary field for the fifth worker is used to record hours related to this ST row.

Check this box when the corresponding adjacent hours/summary field for the fifth worker is used to record hours related to this ST row.

Enter any short supplemental code or note associated with the hourly wage entry for this worker, if applicable.

Enter the hourly wage rate paid to the worker for straight time and overtime for the work shown.

Enter the total fringe benefit credit amount claimed for this worker for the pay period.

Enter any cash payment made to the worker in lieu of fringe benefits for this pay period.

Enter the gross wages earned by the worker for the certified work represented on this line.

Enter the worker's total gross earnings for all work during the pay period.

Enter the total tax withholding amounts deducted from the worker's pay during the pay period.

Enter the total FICA (Social Security and Medicare) deductions taken from the worker's pay.

Enter any other deductions withheld from the worker's pay and identify the deduction type as required by the form's instructions.

Enter the sum of all deductions withheld from the worker's pay for the pay period.

Enter the payroll table entry number assigned to this worker row.

Enter the total straight-time hours worked by this worker for the week on this row.

Enter the trade or labor classification (e.g., Carpenter, Electrician, Laborer) for the sixth worker.

Enter the sixth worker's family/last name exactly as it should appear on the payroll.

Enter the sixth worker's given/first name exactly as it should appear on the payroll.

Enter the sixth worker's middle initial, if any.

Enter the employer- or registration-assigned identifying number for the sixth worker (badge, ID, or registration number).

Indicate the sixth worker's status as a journeyworker or registered apprentice (enter the applicable code or designation).

Enter the total straight-time hours the sixth worker worked during the payroll week.

Enter the straight-time hourly wage rate paid to the sixth worker.

Check this box to indicate the sixth worker performed straight‑time (ST) work on that specific day in the 'Hours Worked Each Day' grid.

Check this box to indicate the sixth worker performed straight‑time (ST) work on that specific day in the 'Hours Worked Each Day' grid.

Enter the sequential entry number assigned to the sixth worker on this payroll roster.

Check this box to indicate the 7th listed worker's straight‑time hours worked for the payroll day represented by this first ST cell.

Enter the hourly wage rate paid to the 7th worker for straight time and overtime for this payroll week.

Enter the payroll entry number for the 7th worker as shown in the leftmost entry-number column.

Check this box to indicate the 7th listed worker's straight‑time hours worked for the payroll day represented by this ST cell.

Enter the total fringe benefit payments made in cash to the 7th worker for this payroll week.

Enter the value of fringe benefits provided (non-cash) to the 7th worker for this payroll week.

Enter the gross earnings for the 7th worker attributable to the labor classification shown on this row for the week.

Enter the total gross earnings for all work performed by the 7th worker during the payroll week.

Enter the last name (surname) of the 7th worker.

Enter the first name of the 7th worker.

Enter the middle initial of the 7th worker, if any.

Enter the identifying number used for the 7th worker (for example, last four of SSN or employer ID).

Enter the journeyman/apprentice indicator or related worker category code for the 7th worker as required by the payroll form.

Enter the labor classification or job title (for example, Carpenter, Laborer) for the 7th worker on this row.

Check this box to indicate the 7th listed worker's straight‑time hours worked for the payroll day represented by this ST cell.

Check this box to indicate the 7th listed worker's straight‑time hours worked for the payroll day represented by this ST cell.

Check this box to indicate the 7th listed worker's straight‑time hours worked for the payroll day represented by this ST cell.

Enter the total number of hours (straight time plus overtime) the 7th worker worked during the payroll week.

Enter the total tax withholdings deducted from the 7th worker's pay for the payroll week.

Enter the amount of any other deductions taken from the 7th worker's pay for the week (specify nature where required by the form).

Enter the total FICA (Social Security/Medicare) taxes withheld from the 7th worker's pay for the payroll week.

Enter the sum of all deductions withheld from the 7th worker's pay for the payroll week.

Enter the leftmost portion of the 7th worker's net pay amount for all work (this box is part of the full net-pay value).

Enter the next portion of the 7th worker's net pay amount for all work (this box is part of the full net-pay value).

Enter the next portion of the 7th worker's net pay amount for all work (this box is part of the full net-pay value).

Enter the next portion of the 7th worker's net pay amount for all work (this box is part of the full net-pay value).

Enter the next portion of the 7th worker's net pay amount for all work (this box is part of the full net-pay value).

Enter the rightmost portion of the 7th worker's net pay amount for all work (this box completes the full net-pay value).

Check this box if the 8th worker (straight time) worked on the first day of the work week represented by this column.

Check this box if the 8th worker (straight time) worked on the second day of the work week represented by this column.

Check this box if the 8th worker (straight time) worked on the third day of the work week represented by this column.

Enter the total federal/state tax withholdings deducted from this worker's pay for the payroll week.

Enter the total FICA (Social Security and Medicare) amount withheld from this worker for the payroll week.

Enter the total amount of any other deductions from this worker's pay for the payroll week and specify the deduction type elsewhere as required.

Enter the sum of all deductions withheld from this worker for the payroll week.

Enter the net amount paid to this worker after all deductions for the payroll week.

Enter any payment reference or check number or short note describing how this worker was paid for the payroll week.

Enter the payroll entry number assigned to this worker (row identifier).

Check this box if the 8th worker (straight time) worked on the fourth day of the work week represented by this column.

Check this box if the 8th worker (straight time) worked on the fifth day of the work week represented by this column.

Check this box if the 8th worker (straight time) worked on the sixth day of the work week represented by this column.

Check this box if the 8th worker (straight time) worked on the seventh day of the work week represented by this column.

Check this box to indicate an additional straight-time hour entry for the 8th worker when applicable for the corresponding day or split shift.

Check this box to indicate an additional straight-time hour entry for the 8th worker when applicable for the corresponding day or split shift.

Check this box to indicate a supplemental straight-time hour entry or adjustment for the 8th worker on the associated day.

Check this box to indicate a supplemental straight-time hour entry or adjustment for the 8th worker on the associated day.

Enter the hourly wage rate paid to this worker (used for both straight time and overtime calculations where applicable).

Enter the total fringe benefit amount attributable to this worker for the payroll week.

Enter any cash payment made in lieu of fringe benefits for this worker during the payroll week.

Enter the gross wages earned by this worker for straight time hours during the payroll week.

Enter the gross wages earned by this worker for overtime hours during the payroll week.

Enter the total gross wages earned by this worker for all hours worked during the payroll week.

Enter any additional gross pay amounts or payroll adjustments applied to this worker for the payroll week.

Enter any numeric value related to gross-pay line items for this worker (use as required by payroll instructions).

Check this box if the 8th worker (straight time) worked in the hours cell corresponding to this column on the payroll row.

Check this box if the 8th worker (straight time) worked in the hours cell corresponding to this column on the payroll row.

Check this box if the 8th worker (straight time) worked in the hours cell corresponding to this column on the payroll row.

Check this box if the 8th worker (straight time) worked in the hours cell corresponding to this column on the payroll row.

Check this box if the 8th worker (straight time) worked in the hours cell corresponding to this column on the payroll row.

Check this box if the 8th worker (straight time) worked in the hours cell corresponding to this column on the payroll row.

Enter the worker's last name (surname) exactly as it should appear on payroll records.

Enter the worker's first name exactly as it should appear on payroll records.

Enter the worker's middle initial, if any.

Enter the worker's identifying number (for example, last four digits of SSN or company ID) used for payroll identification.

Enter whether the worker is a journeyworker, registered apprentice, or other status as used by your payroll (e.g., 'J', 'RA').

Enter the worker's labor classification or trade (for example, Carpenter, Electrician) for this payroll entry.

Enter any registration, apprenticeship, or additional classification identifiers required for this worker.

Check this box to indicate an other or split straight-time hours entry for the 8th worker when applicable for the associated day.

Enter the total number of straight-time hours worked by this worker during the payroll week.

Enter the amount for any other specific deduction listed in the 'Other' deductions column for this worker.

Enter the total deductions for this worker as shown in the alternate/summary deductions column.

Enter the net pay to the worker after all deductions as shown in the alternate/net-pay column.

Check this box to indicate an other or split straight-time hours entry for the 8th worker when applicable for the associated day.

Check this box to indicate an other or split straight-time hours entry for the 8th worker when applicable for the associated day.

Check this box to indicate an other or split straight-time hours entry for the 8th worker when applicable for the associated day.

Check this box to indicate an other or split straight-time hours entry for the 8th worker when applicable for the associated day.

Enter the total number of overtime hours worked by this worker during the payroll week.

Enter the official name of the project or job site associated with this payroll.

Enter the project number or contract number assigned to this job as shown in your contract records.

Enter the certified payroll number assigned to this payroll submission for tracking purposes.

Enter the legal business name of the prime contractor or subcontractor completing this payroll form. Fill only if 'Prime Contractor', 'Subcontractor' is 'Yes' (any).

Enter the location where the work was performed (such as street address, city, county, and state).

Enter the wage determination number applicable to this project as shown on the contract or wage decision.

Enter the week ending date for the payroll period being reported.

Check this box to indicate the employee worked on the first day of the payroll work week and you are recording hours for that day.

Check this box to indicate the employee worked on the second day of the payroll work week and you are recording hours for that day.

Check this box to indicate the employee worked on the third day of the payroll work week and you are recording hours for that day.

Check this box to indicate the employee worked on the fourth day of the payroll work week and you are recording hours for that day.

Enter a brief or abbreviated project name or short identifier for the project.

Enter the short payroll number or short identifier assigned to this payroll.

Enter the full project name as shown on contract documents.

Enter the project's official number or the contract number assigned by the owner or contracting agency.

Enter the payroll number assigned to this payroll statement.

Enter the legal business name of the prime contractor or subcontractor responsible for the payroll.

Enter a short site location code or brief description identifying the project location.

Enter the certifying official's name and title in short form or initials as needed.

Enter the full address or detailed location description for the project site.

Enter the week ending date for the payroll period being reported.

Enter the full name and job title of the person certifying the payroll information.

Enter the certifying official’s handwritten or electronic signature (full name) to certify the payroll statement.

Enter the certifying official’s email address for contact regarding this payroll certification.

Enter the date on which the certifying official signed this form.

Enter the certifying official’s main telephone number, including area code and any extension if applicable.

Enter the certifying official’s full printed or typed name.

Enter the job title or position of the certifying official who signs the form.

Enter the three-digit area code portion of the certifying official’s telephone number.

Enter the three-digit prefix (first three digits after the area code) of the telephone number.

Enter the final four digits of the certifying official’s telephone number.

Enter a telephone extension or any additional short contact code for the certifying official, if applicable.

Check this box if you are submitting the final Davis‑Bacon and Related Acts (DBRA) certified payroll form for this project.

Check this box if the entity submitting this form is the prime contractor on the contract/project.

Check this box if the entity submitting this form is a subcontractor on the contract/project.