Form WH-347, Payroll for Contractors Instructions
This form contains 324 fields organized into 29 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Contractor / Payroll Header | ||
| Name of Contractor | Checkbox |
Check this box when the name entered in the adjacent field is the prime contractor responsible for the payroll.
|
| Name of Subcontractor | Checkbox |
Check this box when the name entered in the adjacent field is a subcontractor (not the prime contractor) responsible for the payroll.
|
| Contractor Name | Text |
Enter the full name of the contractor or subcontractor responsible for this payroll.
|
| Contractor Address | Text |
Enter the contractor's address for this payroll record (street address, city, state, and ZIP as appropriate).
|
| Payroll Number | Text |
Enter the payroll number or identifier assigned to this payroll report.
|
| Week Ending Date | Date |
Enter the week-ending date for the payroll period covered by this form.
|
| Project and Location | Text |
Enter the name and physical location of the project associated with this payroll.
|
| Project or Contract Number | Text |
Enter the project or contract number assigned to this job or contract.
|
| Day/Date Column 1 | Date |
Enter the day and date for the first day of the workweek shown in this column.
|
| Day/Date Column 2 | Date |
Enter the day and date for the second day of the workweek shown in this column.
|
| Day/Date Column 3 | Date |
Enter the day and date for the third day of the workweek shown in this column.
|
| Day/Date Column 4 | Date |
Enter the day and date for the fourth day of the workweek shown in this column.
|
| Day/Date Column 5 | Date |
Enter the day and date for the fifth day of the workweek shown in this column.
|
| Day/Date Column 6 | Date |
Enter the day and date for the sixth day of the workweek shown in this column.
|
| Day/Date Column 7 / Total Hours Header | Date |
Enter the day and date for the seventh day of the workweek shown in this column or use this column header for total hours as applicable.
|
| Withholding Tax Deduction | Number |
Enter the amount withheld for income tax from the employee's pay for the week.
|
| Other Deductions | Number |
Enter any other deduction amounts (non-FICA, non-withholding) taken from the employee's pay for the week.
|
| Hours Worked — Day 1 | Number |
Enter the number of hours worked by the employee on the first day of the payroll week.
|
| Hours Worked — Day 2 | Number |
Enter the number of hours worked by the employee on the second day of the payroll week.
|
| Hours Worked — Day 3 | Number |
Enter the number of hours worked by the employee on the third day of the payroll week.
|
| Hours Worked — Day 4 | Number |
Enter the number of hours worked by the employee on the fourth day of the payroll week.
|
| Hours Worked — Day 5 | Number |
Enter the number of hours worked by the employee on the fifth day of the payroll week.
|
| Total Hours for Week | Number |
Enter the total number of hours worked by the employee for the entire payroll week.
|
| Contractor / Payroll Period / Project Info | ||
| Contractor / Employer Name | Text |
Enter the full legal name of the contractor or subcontractor that employs the persons covered by this payroll.
|
| Building or Work (Project) | Text |
Enter the name or brief description of the building, work, or project (and location) where the labor was performed.
|
| Payroll Period Start — Day | Text |
Enter the day of the month on which the payroll period begins.
|
| Payroll Period Start — Month | Text |
Enter the month when the payroll period begins (name or abbreviation).
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| Payroll Period Start — Year | Text |
Enter the year when the payroll period begins.
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| Payroll Period End — Day | Text |
Enter the day of the month on which the payroll period ends.
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| Payroll Period End — Month | Text |
Enter the month when the payroll period ends (name or abbreviation).
|
| Payroll Period End — Year | Text |
Enter the year when the payroll period ends.
|
| Contractor/Subcontractor (Referenced Entity) | Text |
Enter the full legal name of the contractor or subcontractor referenced in this statement (the entity on whose behalf rebates would be made, if any).
|
| Deductions | ||
| Permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A | Text |
Enter permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A.
|
| Permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A | Text |
Enter permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A.
|
| Permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A | Text |
Enter permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A.
|
| Permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A | Text |
Enter permissible deductions as defined in Regulation, Part 3 29 CFR Subtitle A.
|
| Where fringe benefits are paid to approved plans, funds, or programs (in addition to basic hourly wages) | Checkbox |
Check this box if fringe benefits for the listed laborers or mechanics were paid to approved plans, funds, or programs in addition to the basic hourly wage rates as indicated on the payroll.
|
| Eighth Employee Row (row 8) | ||
| Daily hours (row 8) | Number |
Enter the hours worked by this employee for each day of the workweek in the daily hours column for row 8.
|
| Employee name / identifying number (row 8) | Text |
Enter the employee's full name and identifying number for row 8 (for example, the last four digits of the employee's Social Security number).
|
| Withholding exemptions (row 8) | Text |
Enter the number of withholding exemptions claimed by this employee for payroll purposes on row 8.
|
| Work classification / job code (row 8) | Text |
Enter the employee's work classification or job code used to classify the type of work performed for row 8.
|
| Total hours (row 8) | Number |
Enter the total hours worked by the employee for the entire workweek shown on row 8.
|
| Rate of pay (row 8) | Number |
Enter the employee's rate of pay for the period shown on row 8.
|
| Gross T8 | Text |
Enter the total gross wages earned by the employee for this payroll period.
|
| FICA withheld (row 8) | Number |
Enter the FICA (Social Security and Medicare) amount withheld from this employee's pay for the week on row 8.
|
| Withholding tax (row 8) | Number |
Enter the federal/state income tax withholding amount deducted from this employee's pay for the week on row 8.
|
| Other deduction 1 (row 8) | Number |
Enter the first other deduction amount (for example union dues or benefit contributions) deducted from this employee's pay for the week on row 8.
|
| Other deduction 2 (row 8) | Number |
Enter the second other deduction amount deducted from this employee's pay for the week on row 8.
|
| Other deduction 3 (row 8) | Number |
Enter the third other deduction amount deducted from this employee's pay for the week on row 8.
|
| Total deductions (row 8) | Number |
Enter the total of all deductions withheld from this employee's pay for the week on row 8.
|
| Net wages paid (row 8) | Number |
Enter the net wages paid to the employee for the week after all deductions on row 8.
|
| Exception Row 1 (Craft / Explanation) | ||
| Exception (Craft) | Text |
Enter the craft, trade, or job classification for the exception row (for example 'Carpenter' or 'Laborer') that identifies which workers the exception applies to.
|
| Explanation | Text |
Enter a brief explanation describing the reason or details of the exception for the craft listed in this row (e.g., scope, hours, wage adjustment, or justification).
|
| Exception Row 2 (Craft / Explanation) | ||
| Exception (Craft) | Text |
Enter the trade, craft, or job classification for which you are claiming an exception (for example 'Carpenter', 'Laborer', or 'Electrician').
|
| Explanation of Exception | Text |
Provide a brief, clear explanation describing why the listed craft qualifies for the exception, including any relevant details or justification specific to this payroll period.
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| Exception Row 3 (Craft / Explanation) | ||
| Exception (Craft) — Row 3 | Text |
Enter the trade or craft classification (for example: Carpenter, Electrician, Laborer) that describes the worker group covered by this exception on row 3.
|
| Explanation — Row 3 | Text |
Provide a brief description explaining the reason for the exception listed in the craft column on row 3, such as the specific fringe benefit arrangement or circumstance that justifies the exception.
|
| Exception Row 4 (Craft / Explanation) | ||
| Exception (Craft) — Row 4 | Text |
Enter the trade, craft, or job classification for the fourth exception row (e.g., 'Carpenter', 'Laborer') as it applies to this payroll entry.
|
| Explanation — Row 4 | Text |
Provide a brief explanation or reason for the exception listed on row 4, describing why the classification or wage differs from the standard (e.g., special duties, apprenticeship status, or other allowance).
|
| Exception Row 5 (Craft / Explanation) | ||
| Exception (Craft) - Row 5 | Text |
Enter the trade or craft classification for the exception being reported in row 5 (for example, 'Carpenter', 'Laborer', or other job classification).
|
| Explanation - Row 5 | Text |
Provide a brief explanation describing the reason or circumstances for the exception listed in row 5 (what makes this worker or pay entry an exception).
|
| Exception Row 6 (Craft / Explanation) | ||
| Exception (Craft) | Text |
Enter the trade, job classification, or craft for which an exception is being claimed (for example: Painter, Carpenter, Laborer).
|
| Explanation | Text |
Provide a brief description explaining the reason for the exception, including facts or circumstances that justify the claimed exception for the craft listed to the left.
|
| Exception Row 7 (Craft / Explanation) | ||
| Exception (Craft) | Text |
Enter the craft, trade, or job classification to which this exception applies (for example, 'Carpenter', 'Laborer', or other specific craft).
|
| Explanation | Text |
Provide a brief explanation describing the reason or details for the exception listed for the corresponding craft.
|
| Exception Row 8 (Craft / Explanation) | ||
| Exception (Craft) | Text |
Enter the trade or craft classification (e.g., Carpenter, Laborer, Electrician) for the exception being reported on this row.
|
| Explanation | Text |
Provide a concise explanation describing the reason for the exception for the craft listed on this row (include circumstances, dates, or other relevant details).
|
| Fifth Employee Row (row 5) | ||
| Employee name and ID | Text |
Enter the employee's full name and identifying number (for example, the last four digits of the Social Security number).
|
| Withholding exemptions | Text |
Enter the number of withholding exemptions claimed by this employee for the payroll period.
|
| Work classification | Text |
Enter the employee's job classification or trade used for this contract (for example, Carpenter, Laborer, etc.).
|
| Total hours worked | Number |
Enter the total hours the employee worked during this payroll week.
|
| Rate of pay | Number |
Enter the employee's hourly rate of pay applicable for this payroll period.
|
| Gross amount earned | Number |
Enter the total gross wages earned by the employee for the week before any deductions.
|
| FICA deduction | Number |
Enter the amount withheld from the employee's wages for FICA taxes for the week.
|
| Withholding tax deduction | Number |
Enter the amount of federal income tax withheld from the employee's wages for the week.
|
| Other deduction (1) | Number |
Enter the amount of any other deduction (for example union dues, insurance) withheld from the employee's wages for the week.
|
| Other deduction (2) | Number |
Enter the amount of any additional deduction not captured in the prior deduction column for this employee for the week.
|
| Total deductions | Number |
Enter the sum of all deduction amounts withheld from the employee's gross wages for the week.
|
| Net wages paid | Number |
Enter the net wages actually paid to the employee for the week after all deductions.
|
| Net wages paid (additional field) | Number |
Use this field for any additional net-pay amount or portion if the form separates the net wages into more than one entry.
|
| Rate of pay ST fringe 6 | Text |
Enter the fringe benefit rate of pay for the employee for this pay period.
|
| Rate of pay ST 7 | Text |
Enter the rate of pay for the standard time hours worked by the employee.
|
| Rate of pay ST fringe 7 | Text |
Enter the rate of pay for the standard time fringe benefits for the employee.
|
| First Employee Row (row 1) | ||
| Employee name and ID | Text |
Enter the employee's full name and an individual identifying number (for example, the last four digits of the employee's Social Security number).
|
| Withholding exemptions | Text |
Enter the number of withholding exemptions the employee claims for this payroll period.
|
| Work classification | Text |
Enter the employee's work classification or job code used on this contract (for example, 'Carpenter', 'Laborer', or the classification code).
|
| Hours worked each day | Number |
Enter the hours worked by the employee for each day of the payroll week in the vertical daily boxes.
|
| Rate of pay | Number |
Enter the employee's rate of pay applicable to the hours reported.
|
| Additional rate / overtime rate | Number |
Enter any additional or overtime rate of pay applicable to this employee (if used).
|
| Hours at additional rate | Number |
Enter the number of hours worked at the additional or overtime rate reported in the adjacent rate field.
|
| Gross amount earned (primary) | Number |
Enter the gross earnings for this employee attributable to the primary rate and hours shown.
|
| Gross amount earned (additional) | Number |
Enter any additional gross earnings for the employee that are not included in the primary gross amount field.
|
| FICA deduction | Number |
Enter the amount withheld from the employee's pay for FICA (Social Security/Medicare) contributions.
|
| Withholding tax (federal) | Number |
Enter the amount of federal income tax withheld from the employee's pay for the week.
|
| Withholding tax (state/local) | Number |
Enter any state or local income tax withheld from the employee's pay for the week.
|
| Other deductions | Number |
Enter the total of any other deductions taken from the employee's pay (for example union dues, insurance, or retirement contributions).
|
| Total deductions | Number |
Enter the sum of all deduction columns for this employee for the payroll week.
|
| Additional deduction/adjustment | Number |
Enter any additional deduction or payroll adjustment amount for this employee not captured in the other deduction columns.
|
| Net wages paid for week | Number |
Enter the net amount actually paid to the employee for the payroll week after all deductions.
|
| Fourth Employee Row (row 4) | ||
| Employee name / ID | Text |
Enter the employee's name and identifying number (for example, name and last four digits of SSN) as shown on payroll records.
|
| Number of withholding exemptions | Text |
Enter the number of federal withholding exemptions the employee claims for this payroll period.
|
| Work classification | Text |
Enter the worker's job classification or trade (for example, carpenter, electrician) used for this project.
|
| Total hours worked | Number |
Enter the total hours the employee worked during the payroll week.
|
| Rate of pay | Number |
Enter the employee's rate of pay.
|
| Gross amount earned | Number |
Enter the employee's total gross wages earned for the week before any deductions.
|
| FICA deduction | Number |
Enter the amount deducted from the employee's pay for FICA this week.
|
| Withholding tax deduction | Number |
Enter the amount withheld for federal income tax from the employee's pay this week.
|
| Other deduction 1 | Number |
Enter the amount of any other deduction (for example union dues or benefit contributions) taken from this employee's pay this week.
|
| Other deduction 2 | Number |
Enter any additional other deduction amount for this employee for the week.
|
| Total deductions | Number |
Enter the total of all deductions taken from this employee's pay for the week.
|
| Net wages (dollars) | Number |
Enter the net wages paid to the employee for the week after all deductions.
|
| Net wages (cents/continuation) | Number |
Enter the remaining portion of the net wages paid to the employee for the week as shown on the form.
|
| rateOfPayST5 | Text |
Enter the rate of pay for straight time hours for the fifth employee.
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| Rate of pay ST fringe 5 | Text |
Enter the rate of pay for straight time fringe benefits for the fifth employee.
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| Rate of pay ST 6 | Text |
Enter the rate of pay for the employee for this pay period.
|
| Fringe Benefits | ||
| Fringe benefits paid in cash | Checkbox |
Check this box when each laborer or mechanic listed on the payroll has been paid, in cash, an amount at least equal to the applicable basic hourly wage plus the required fringe benefits as indicated on the payroll.
|
| Name and Title (Signature Area) | ||
| Name and Title of Signatory | Text |
Enter the full printed name and job title of the person signing this form (the signatory responsible for the payroll certification).
|
| Overtime Hours | ||
| OT21 | Text |
Enter the overtime hours worked by the second worker on day 1.
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| OT22 | Text |
Enter the overtime hours worked by the second worker on day 2.
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| OT23 | Text |
Enter the overtime hours worked by the second worker on day 3.
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| OT24 | Text |
Enter the overtime hours worked by the second worker on day 4.
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| OT25 | Text |
Enter the overtime hours worked by the second worker on day 5.
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| OT26 | Text |
Enter the overtime hours worked by the second worker on day 6.
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| OT27 | Text |
Enter the overtime hours worked by the second worker on day 7.
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| Total hours OT2 | Text |
Enter the total overtime hours worked by the second worker.
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| OT51 | Text |
Enter the overtime hours worked by the fifth employee on the first day.
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| OT52 | Text |
Enter the overtime hours worked by the fifth employee on the second day.
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| OT53 | Text |
Enter the overtime hours worked by the fifth employee on the third day.
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| OT54 | Text |
Enter the overtime hours worked by the fifth employee on the fourth day.
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| OT55 | Text |
Enter the overtime hours worked by the fifth employee on the fifth day.
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| OT56 | Text |
Enter the overtime hours worked by the fifth employee on the sixth day.
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| OT57 | Text |
Enter the overtime hours worked by the fifth employee on the seventh day.
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| Total hours OT5 | Text |
Enter the total overtime hours worked by the fifth employee.
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| OT61 | Text |
Enter the overtime hours for the sixth employee on day 1.
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| OT62 | Text |
Enter the overtime hours for the sixth employee on day 2.
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| OT63 | Text |
Enter the overtime hours for the sixth employee on day 3.
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| OT64 | Text |
Enter the overtime hours for the sixth employee on day 4.
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| OT65 | Text |
Enter the overtime hours for the sixth employee on day 5.
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| OT66 | Text |
Enter the overtime hours for the sixth employee on day 6.
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| OT67 | Text |
Enter the overtime hours for the sixth employee on day 7.
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| Total hours OT6 | Text |
Enter the total overtime hours for the sixth employee.
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| Payroll Details | ||
| day1 | Text |
Enter the hours worked on Day 1.
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| Day 2 | Text |
Enter the hours worked on Day 2.
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| Day 3 | Text |
Enter the hours worked on Day 3.
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| Day 4 | Text |
Enter the hours worked on Day 4.
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| Day 5 | Text |
Enter the hours worked on Day 5.
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| Day 6 | Text |
Enter the hours worked on Day 6.
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| Day 7 | Text |
Enter the hours worked on Day 7.
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| date1 | Text |
Enter the date for Day 1 in mm/dd/yyyy format.
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| Date 2 | Text |
Enter the date for Day 2 in mm/dd/yyyy format.
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| Date 3 | Text |
Enter the date for Day 3 in mm/dd/yyyy format.
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| Date 4 | Text |
Enter the date for Day 4 in mm/dd/yyyy format.
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| Date 5 | Text |
Enter the date for Day 5 in mm/dd/yyyy format.
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| Date 6 | Text |
Enter the date for Day 6 in mm/dd/yyyy format.
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| Date 7 | Text |
Enter the date for Day 7 in mm/dd/yyyy format.
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| OT11 | Text |
Enter the number of overtime hours worked by the employee on day 1.
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| OT12 | Text |
Enter the number of overtime hours worked by the employee on day 2.
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| OT13 | Text |
Enter the number of overtime hours worked by the employee on day 3.
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| OT14 | Text |
Enter the number of overtime hours worked by the employee on day 4.
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| OT15 | Text |
Enter the number of overtime hours worked by the employee on day 5.
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| OT16 | Text |
Enter the number of overtime hours worked by the employee on day 6.
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| OT17 | Text |
Enter the number of overtime hours worked by the employee on day 7.
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| Total hours OT1 | Text |
Enter the total number of overtime hours worked by the employee for the week.
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| ST11 | Text |
Enter the number of straight time hours worked by the employee on day 1.
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| ST12 | Text |
Enter the number of straight time hours worked by the employee on day 2.
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| ST13 | Text |
Enter the number of straight time hours worked by the employee on day 3.
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| ST14 | Text |
Enter the number of straight time hours worked by the employee on day 4.
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| ST15 | Text |
Enter the number of straight time hours worked by the employee on day 5.
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| ST16 | Text |
Enter the number of straight time hours worked by the employee on day 6.
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| ST17 | Text |
Enter the number of straight time hours worked by the employee on day 7.
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| Total hours ST1 | Text |
Enter the total number of straight time hours worked by the employee for the week.
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| Total hours ST2 | Text |
Enter the total number of standard time (ST) hours worked by the employee in the second period.
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| OT31 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| OT32 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| OT33 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| OT34 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| OT35 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| OT36 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| OT37 | Text |
Enter the overtime (OT) hours worked by the employee in the third period.
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| Total hours OT3 | Text |
Enter the total number of overtime (OT) hours worked by the employee in the third period.
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| ST31 | Text |
Enter the standard time hours worked by the third worker on the first day.
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| ST32 | Text |
Enter the standard time hours worked by the third worker on the second day.
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| ST33 | Text |
Enter the standard time hours worked by the third worker on the third day.
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| ST34 | Text |
Enter the standard time hours worked by the third worker on the fourth day.
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| ST35 | Text |
Enter the standard time hours worked by the third worker on the fifth day.
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| ST36 | Text |
Enter the standard time hours worked by the third worker on the sixth day.
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| ST37 | Text |
Enter the standard time hours worked by the third worker on the seventh day.
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| Total hours ST3 | Text |
Enter the total standard time hours worked by the third worker.
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| OT41 | Text |
Enter the overtime hours worked by the fourth worker on the first day.
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| OT42 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| OT43 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| OT44 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| OT45 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| OT46 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| OT47 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| Total hours OT4 | Text |
Enter the total overtime hours worked by the employee for the specified period.
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| ST41 | Text |
Enter the standard hours worked by the employee for the specified period.
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| ST42 | Text |
Enter the standard hours worked by the employee for the specified period.
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| ST43 | Text |
Enter the standard hours worked by the employee for the specified period.
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| ST44 | Text |
Enter the standard hours worked by the employee for the specified period.
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| ST45 | Text |
Enter the standard hours worked by the employee for the specified period.
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| ST46 | Text |
Enter the standard hours worked by the employee for the specified period.
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| ST47 | Text |
Enter the standard hours worked by the employee for the specified period.
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| Total hours ST4 | Text |
Enter the total standard hours worked by the employee for the specified period.
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| Total hours ST6 | Text |
Enter the total hours worked by the employee for this pay period.
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| OT71 | Text |
Enter the overtime hours worked by the employee for this pay period.
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| OT72 | Text |
Enter the overtime hours worked by the employee for this pay period.
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| OT73 | Text |
Enter the overtime hours worked by the employee for this pay period.
|
| OT74 | Text |
Enter the overtime hours worked by the employee for this pay period.
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| OT75 | Text |
Enter the overtime hours worked by the employee for this pay period.
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| OT76 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| OT77 | Text |
Enter the overtime hours worked by the employee for the specified period.
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| Total hours OT7 | Text |
Enter the total overtime hours worked by the employee for the specified period.
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| ST71 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| ST72 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| ST73 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| ST74 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| ST75 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| ST76 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| ST77 | Text |
Enter the standard time hours worked by the employee for the specified period.
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| Total hours ST7 | Text |
Enter the total standard time hours worked by the employee for the specified period.
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| OT81 | Text |
Enter the overtime hours worked by the employee on the first day of the payroll period.
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| OT82 | Text |
Enter the overtime hours worked by the employee on the second day of the payroll period.
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| OT83 | Text |
Enter the overtime hours worked by the employee on the third day of the payroll period.
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| OT84 | Text |
Enter the overtime hours worked by the employee on the fourth day of the payroll period.
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| OT85 | Text |
Enter the overtime hours worked by the employee on the fifth day of the payroll period.
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| OT86 | Text |
Enter the overtime hours worked by the employee on the sixth day of the payroll period.
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| OT87 | Text |
Enter the overtime hours worked by the employee on the seventh day of the payroll period.
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| Total hours OT8 | Text |
Enter the total overtime hours worked by the employee during the payroll period.
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| ST81 | Text |
Enter the straight time hours worked by the employee on the first day of the payroll period.
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| ST82 | Text |
Enter the straight time hours worked by the employee on the second day of the payroll period.
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| ST83 | Text |
Enter the straight time hours worked by the employee on the third day of the payroll period.
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| ST84 | Text |
Enter the straight time hours worked by the employee on the fourth day of the payroll period.
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| ST85 | Text |
Enter the straight time hours worked by the employee on the fifth day of the payroll period.
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| ST86 | Text |
Enter the straight time hours worked by the employee on the sixth day of the payroll period.
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| ST87 | Text |
Enter the straight time hours worked by the employee on the seventh day of the payroll period.
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| Total hours ST8 | Text |
Enter the total straight time hours worked by the employee during the payroll period.
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| Project Information | ||
| ST64 | Text |
Enter the state abbreviation for the project location.
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| ST65 | Text |
Enter the state abbreviation for the project location.
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| ST66 | Text |
Enter the state abbreviation for the project location.
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| ST67 | Text |
Enter the state abbreviation for the project location.
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| Remarks | ||
| Remarks / Additional Information | Text |
Enter any additional comments, explanations, exceptions, or other relevant information about the payroll, fringe benefits, apprenticeships, or certification statements required by this form.
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| Second Employee Row (row 2) | ||
| Employee name | Text |
Enter the full name of the employee whose pay is reported on this row.
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| Employee identifying number | Text |
Enter the worker's individual identifying number (for example, the last four digits of the employee's Social Security number).
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| Work classification | Text |
Enter the employee's job classification, trade or work code that applies to the hours shown.
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| Total hours worked | Number |
Enter the total number of hours the employee worked during the payroll week.
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| Rate of pay (part 1) | Number |
Enter the employee's rate of pay applicable to the hours reported in this row.
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| Rate of pay (part 2) | Number |
Enter any additional or alternate rate of pay for this employee (leave blank if not used).
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| Gross amount earned (part 1) | Number |
Enter the gross wages earned by the employee for the hours shown before any deductions.
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| Gross amount earned (part 2) | Number |
Enter any additional gross pay for this employee for the pay period (e.g., separate pay component or continuation of the gross amount).
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| FICA withheld | Number |
Enter the amount withheld from this employee's pay for FICA taxes for the week.
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| Withholding tax withheld (federal/state) | Number |
Enter the amount withheld from the employee's pay for income tax (federal and/or state as applicable) for the week.
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| Other deductions (part 1) | Number |
Enter any other payroll deductions taken from the employee's pay (such as union dues, loan payments, or benefit contributions).
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| Other deductions (part 2) | Number |
Enter any additional other deduction amounts for this employee for the pay period (leave blank if not used).
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| Total deductions | Number |
Enter the sum of all deductions withheld from the employee's gross wages for the week.
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| Net wages paid (part 1) | Number |
Enter the net wages paid to the employee for the week after all deductions are subtracted from gross pay.
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| Net wages paid (part 2) | Number |
Enter any additional net wage amount or continuation of the net wages figure for this employee if the form splits the amount across multiple boxes.
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| Rate of pay ST 3 | Text |
Enter the standard rate of pay for the third worker.
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| Seventh Employee Row (row 7) | ||
| Employee name and ID | Text |
Enter the employee's name and individual identifying number (typically the last four digits of the Social Security number).
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| Withholding exemptions | Text |
Enter the number of federal withholding exemptions claimed by this employee for the pay period.
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| Work classification | Text |
Enter the worker's job classification code or brief job title used for this contract or payroll record.
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| Total hours worked | Number |
Enter the total hours the employee worked during the pay period.
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| Rate of pay | Number |
Enter the employee's pay rate for this pay period (hourly or other applicable rate).
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| Gross amount earned | Number |
Enter the total gross wages earned by the employee for the pay period before deductions.
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| FICA deduction | Number |
Enter the amount withheld from the employee's pay for FICA (Social Security/Medicare) for this pay period.
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| Withholding tax deduction | Number |
Enter the amount withheld from the employee's pay for federal (and applicable state) income tax for this pay period.
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| Other deduction 1 | Number |
Enter the amount of any other deduction (for example union dues or benefit contributions) withheld from this employee's pay for the pay period.
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| Other deduction 2 | Number |
Enter the amount of an additional other deduction withheld from this employee's pay for the pay period.
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| Other deduction 3 | Number |
Enter the amount of any further other deduction withheld from this employee's pay for the pay period.
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| Total deductions | Number |
Enter the sum of all deductions withheld from the employee's pay for the pay period.
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| Net wages paid | Number |
Enter the net wages actually paid to the employee for the week after all deductions.
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| Signatory Info | ||
| Date | Date |
Enter the date when the signatory is completing and signing this form.
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| Name of Signatory | Text |
Enter the full name of the person (signatory party) who is attesting to and signing the form.
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| Signatory Title | Text |
Enter the official job title or position of the signatory (for example, Owner, Manager, or Project Superintendent).
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| Sixth Employee Row (row 6) | ||
| Employee name and ID | Text |
Enter the employee's full name and identifying number (for example, last four digits of the Social Security number) as shown on payroll records.
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| Number of withholding exemptions | Text |
Enter the number of withholding exemptions claimed by the employee for payroll withholding purposes.
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| Work classification | Text |
Enter the worker's job classification or trade code used to categorize the type of work performed.
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| Total hours worked | Number |
Enter the total hours the employee worked during the pay week.
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| Rate of pay | Number |
Enter the employee's pay rate corresponding to the hours worked.
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| Gross amount earned | Number |
Enter the total gross wages earned by the employee for the pay week before any deductions.
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| FICA deduction | Number |
Enter the amount withheld from the employee's pay for FICA (Social Security/Medicare) for the pay period.
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| Withholding tax deduction | Number |
Enter the amount withheld from the employee's pay for federal income tax withholding for the pay period.
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| Other deduction 1 | Number |
Enter the first other deduction amount withheld from the employee's pay (e.g., union dues, loan repayment) for the pay period.
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| Other deduction 2 | Number |
Enter the second other deduction amount withheld from the employee's pay for the pay period, if applicable.
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| Other deduction 3 | Number |
Enter the third other deduction amount withheld from the employee's pay for the pay period, if applicable.
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| Total deductions | Number |
Enter the sum of all deductions withheld from the employee's pay for the pay week.
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| Net wages paid for week | Number |
Enter the employee's net pay for the week after all deductions have been applied.
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| Row-specific code or note (1) | Text |
Enter any short internal code, classification note, or brief remark associated with this employee's row as required by the contractor.
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| Row-specific code or note (2) | Text |
Enter any additional short internal code or supplemental note for payroll processing related to this employee's row.
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| Standard Hours | ||
| ST21 | Text |
Enter the standard hours worked by the second worker on day 1.
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| ST22 | Text |
Enter the standard hours worked by the second worker on day 2.
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| ST23 | Text |
Enter the standard hours worked by the second worker on day 3.
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| ST24 | Text |
Enter the standard hours worked by the second worker on day 4.
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| ST25 | Text |
Enter the standard hours worked by the second worker on day 5.
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| ST26 | Text |
Enter the standard hours worked by the second worker on day 6.
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| ST27 | Text |
Enter the standard hours worked by the second worker on day 7.
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| ST61 | Text |
Enter the standard time hours for the sixth employee on day 1.
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| ST62 | Text |
Enter the standard time hours for the sixth employee on day 2.
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| ST63 | Text |
Enter the standard time hours for the sixth employee on day 3.
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| Straight Time Hours | ||
| ST51 | Text |
Enter the straight time hours worked by the fifth employee on the first day.
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| ST52 | Text |
Enter the straight time hours worked by the fifth employee on the second day.
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| ST53 | Text |
Enter the straight time hours worked by the fifth employee on the third day.
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| ST54 | Text |
Enter the straight time hours worked by the fifth employee on the fourth day.
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| ST55 | Text |
Enter the straight time hours worked by the fifth employee on the fifth day.
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| ST56 | Text |
Enter the straight time hours worked by the fifth employee on the sixth day.
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| ST57 | Text |
Enter the straight time hours worked by the fifth employee on the seventh day.
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| Total hours ST5 | Text |
Enter the total straight time hours worked by the fifth employee.
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| Third Employee Row (row 3) | ||
| Employee name / ID | Text |
Enter the employee's full name and identifying number (for example, the last four digits of the employee's Social Security number).
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| Employee count/Exemptions | Text |
Enter the small numeric count required by the form for this worker (for example, number of exemptions or classification count).
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| Work classification | Text |
Enter the employee's job classification, trade, or job code used on this payroll entry.
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| Total hours | Number |
Enter the total hours worked by this employee for the week.
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| Overtime / alternate hours | Number |
Enter the hours worked at overtime or an alternate rate for this employee for the week, if any.
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| Rate of pay | Number |
Enter the employee's hourly rate of pay.
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| Gross amount earned | Number |
Enter the gross wages earned by the employee for the week before any deductions.
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| FICA withheld | Number |
Enter the amount of FICA (Social Security/Medicare) tax withheld from the employee's pay for the week.
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| Withholding tax | Number |
Enter the amount of federal or state withholding tax withheld from this employee for the week.
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| Other deduction 1 | Number |
Enter any other individual deduction (for example union dues or benefit contributions) withheld from this employee this week.
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| Other deduction 2 | Number |
Enter any additional deduction withheld from this employee for the week.
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| Total deductions | Number |
Enter the total of all deductions withheld from the employee's pay for the week.
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| Net wages paid (part 1) | Number |
Enter the net wages paid to the employee for the week (this field is one part of the net pay entry).
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| Net wages paid (part 2) | Number |
Enter the net wages paid to the employee for the week (this field is the adjacent part of the net pay entry).
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| Rate of pay ST 4 | Text |
Enter the rate of pay for the standard hours worked by the employee.
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| Rate of pay ST fringe 4 | Text |
Enter the fringe benefit rate of pay for the standard hours worked by the employee.
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| Wages / Deductions Description | ||
| Wages / Deductions Description | Text |
Enter a clear, concise description of the wages, deductions, fringe benefits or other payroll items for the payroll period, including any relevant categories, explanations or notes needed to explain amounts shown on the payroll. Fill only if 'Where fringe benefits are paid to approved plans, funds, or programs (in addition to basic hourly wages)' is 'Yes'.
Depends on:
Where fringe benefits are paid to approved plans, funds, or programs (in addition to basic hourly wages)
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