Form WH-226, Application for Authority to Employ Workers with Disabilities at Subminimum Wages Instructions

Enter the application contact person’s first and last name and title.

Enter the application contact person’s e-mail address.

Check this box if the application is for a Community Rehabilitation Program (Work Center).

Check this box if the application is for workers at a hospital or residential care facility who are patient workers.

Check this box if the application is for a School Work Experience Program (SWEP).

Check this box if the application is for a business establishment.

Check this box if this is an initial application.

Check this box if this is a renewal application.

Provide the signature of the person completing the form.

Enter the authorized representative’s first and last name.

Enter the authorized representative’s title.

Enter the date the authorized representative signed the form.

Check 'Yes' if the employer has reviewed and verified documentation that counseling and referrals have been provided to each worker paid at a subminimum wage, and each has been informed of available training opportunities as required by WIOA.

Check 'No' if the employer has not reviewed and verified documentation that counseling and referrals have been provided to each worker paid at a subminimum wage, and each has been informed of available training opportunities as required by WIOA.

Enter the date when the contact with the source employer was made.

Enter the date when the contact with the source employer was made.

Enter the name and title of the individual contacted at the source employer.

Enter the name and title of the individual contacted at the source employer.

Enter the name and title of the individual contacted at the source employer.

Enter the name and title of the individual contacted at the source employer.

Provide the contact information for source employers, including name, address, and phone number.

Enter the name and title of the individual contacted at the source employer.

Enter the date when contact was made regarding the job or task.

Provide the name, address, and phone number of the source employers contacted.

Enter the name and title of the individual contacted at the source employer.

Enter the date when contact was made with the source employer.

Provide the name, address, and phone number of the source employers contacted.

Enter the name and title of the individual contacted at the source employer.

Enter the date when contact was made with the source employer.

Check this box if the job or contract identified in Item 9(b) is covered by the Service Contract Act (SCA).

Check this box if the job or contract identified is covered by the Service Contract Act (SCA). Attach the applicable SCA wage determination instead of completing the chart.

Check this box if applicable.

Enter the date when the data was retrieved for the third instance.

Enter the date when the data was retrieved for the second instance.

Enter the date when the data was retrieved for the first instance.

Enter the date when the data was retrieved for the wage rate determination.

Enter the date when the data was retrieved for the wage rate determination.

Enter the date when the data was retrieved for the wage rate determination.

Check this option if the employer is a local or State educational agency.

Check this option if the employer is not a local or State educational agency.

Enter the employer’s prior name or names if they have changed since the last application.

Enter the employer’s street address.

Enter the ZIP code for the employer’s address. Fill only if 'Street Address' is different from field 5.

Enter the state for the employer’s address. Fill only if 'Street Address' is different from field 5.

Enter the county for the employer’s address. Fill only if 'Street Address' is different from field 5.

Enter the city for the employer’s address. Fill only if 'Street Address' is different from field 5.

Enter the contact information (name, address, phone number) for the source employer related to the job or contract.

Enter the contact information (name, address, phone number) for the source employer related to the job or contract.

Provide the name and title of the individual contacted at the source employer related to the job or contract.

Provide the name and title of the individual contacted at the source employer related to the job or contract.

Enter the date when contact was made with the source employer regarding the job or contract.

Enter the contact information (name, address, phone number) for the source employer.

Enter the contact information (name, address, phone number) for the source employer.

Enter the contact information (name, address, phone number) for the source employer.

Enter the contact information (name, address, phone number) for the source employer.

Enter the employer’s fax number.

Enter the employer’s telephone number.

Enter the employer’s Federal Employer Identification Number.

Enter the employer’s legal name.

Enter the employer’s trade name, if different from its legal name.

If the employer’s name has changed since the last application, enter its prior name or names.

Check this box if the employer was a representative payee for any worker with disabilities and received Social Security Benefits on behalf of that employee during the most recently completed fiscal quarter.

If the employer was a representative payee, enter the total number of workers with disabilities for whom the facility was a representative payee during the most recently completed fiscal quarter.

Check this box if the employer took credit for the cost of providing facilities, such as board, lodging, and transportation, toward meeting wage obligations during the most recently completed fiscal quarter.

Specify the type of deduction taken, such as transportation, rent, or meals.

Enter the employer’s status if none of the listed status options applies. Fill only if 'Other' is 'Yes'.

Check this option if the employer’s status is Public (State or Local Government).

Check this option if the employer’s status is Private, Not For Profit.

Check this option if the employer’s status is Private, For Profit.

Check this option if the employer’s status is not one of the listed categories, and enter the status in the space provided.

If the employer employed workers with disabilities who received subminimum wages and were paid piece rates during the most recently completed fiscal quarter, enter the number of such workers.

Check this box if the employer employed workers with disabilities who received subminimum wages and were paid piece rates during the most recently completed fiscal quarter.

Check this box if the employer did not employ workers with disabilities who received subminimum wages and were paid piece rates during the most recently completed fiscal quarter. If checked, proceed to Item 13 of the form.

Check this option if the employer does not manufacture items for the Federal Government under the PCA.

Check this option if the employer manufactures items for the Federal Government under the PCA.

Check this option if the employer has entered into a Federal Government contract for services or concessions that may be subject to Executive Order 13658 or 14026.

Check this option if the employer has not entered into a Federal Government contract for services or concessions that may be subject to Executive Order 13658 or 14026.

Check this option if the employer has not entered into such a Federal Government contract but intends to do so within the next two years.

Enter the year when the employer’s most recently completed fiscal quarter ended.

Enter the day of the month when the employer’s most recently completed fiscal quarter ended.

Enter the month when the employer’s most recently completed fiscal quarter ended.

Provide a brief description of the job task performed by the worker.

Provide a brief description of the job task performed by the worker.

Provide a description of the work, including the job classification code if known, for the job or contract identified.

Describe the work performed on the job or contract by workers who were paid subminimum wages.

Provide the name of the job or contract associated with the employment of workers paid subminimum wages.

Describe the work performed on the job or contract by workers who are paid subminimum wages.

Provide a brief description of the job or task associated with the employment of workers paid subminimum wages.

Provide a brief description of the job or task associated with the employment of workers paid subminimum wages.

Provide a brief description of the job or task discussed during the contact.

Provide a brief description of the job or task discussed with the source employer.

Provide a brief description of the job or task discussed with the source employer.

Provide a detailed description of the work being performed, including the job classification code if it is known.

Provide the standard productivity level expected for the job described.

Provide a description of the work being performed.

Provide the name of the job or contract on which the employer employed the largest number of workers who received subminimum wages and were paid piece rates during the most recently completed fiscal quarter.

Enter the total number of current SCA-covered contracts under which workers with disabilities are employed and earning subminimum wages. Fill only if 'Yes — Currently Holds SCA-Covered Contracts' is 'Yes'.

Enter the total number of establishments and work sites where workers with disabilities have been or will be employed at subminimum wages and covered by this certificate.

Enter the mailing street address of the parent organization. Fill only if 'Legal Name of Employer' is different from field 1.

Enter the ZIP code for the parent organization's mailing address. Fill only if 'Send Mail to Parent Organization' is 'Yes'.

Enter the state for the parent organization's mailing address. Fill only if 'Send Mail to Parent Organization' is 'Yes'.

Enter the county for the parent organization's mailing address. Fill only if 'Send Mail to Parent Organization' is 'Yes'.

Enter the city for the parent organization's mailing address. Fill only if 'Send Mail to Parent Organization' is 'Yes'.

Check this box if mail should be sent to the parent organization instead of the employer’s address listed in Item 2.

Enter the legal name of the parent organization. Fill only if 'Legal Name of Employer' is different from field 1.

Enter the trade name of the parent organization. Fill only if 'Legal Name of Employer' is different from field 1.

Check this box if the employer has previously applied for a 14(c) certificate.

Check this box if the employer has never previously applied for a 14(c) certificate.

Check this box if the employer has previously held a 14(c) certificate.

Check this box if the employer has never previously held a 14(c) certificate.

Enter the number of the most recently held 14(c) certificate. Fill only if 'Yes — previously held a 14(c) certificate' is 'Yes'.

Check this option if the employer currently holds any contracts covered by the SCA.

Check this option if the employer does not currently hold any contracts covered by the SCA.

Check this option if the employer does not currently hold SCA-covered contracts but intends to hold them within the next two years.

Check this box if the form is being completed by a vocational rehabilitation program administered by a state agency or the U.S. Veterans Administration for temporary authority.

Enter the total number of workers with disabilities employed at subminimum wages during the most recently completed fiscal quarter at all establishments and work sites.

Enter the number of workers with disabilities who were paid hourly subminimum wage rates during the most recently completed fiscal quarter, if applicable.

Indicate if the employer paid hourly subminimum wage rates to workers with disabilities during the most recently completed fiscal quarter.

Indicate if the employer did not pay hourly subminimum wage rates to workers with disabilities during the most recently completed fiscal quarter.

Enter the wage provided to an experienced worker for the specified job task.

Enter the wage provided to an experienced worker for the specified job task.

Enter the wage provided to an experienced worker for the specified job task.

Enter the wage provided to an experienced worker for the job or task.

Enter the wage provided to an experienced worker for the job or task at the source employer.

Enter the wage provided to an experienced worker for the job or task at the source employer.

Enter the wage provided to an experienced worker for the job or task.

Provide the prevailing wage as determined by the source for the job described.

Specify any alternative data source used for determining the prevailing wage.

Enter the piece rate paid to workers for the job described.

Enter the prevailing wage determined for the job described.

Provide the reasoning for why the wage rate is not based on an entry-level position.

Provide the reasoning for why the wage rate is not based on an entry-level position.

Explain the basis for concluding that the wage rate is not based on an entry-level position.

Explain the basis for concluding that the wage rate at the source employer is not based on an entry-level position.

Explain the basis for concluding that the wage rate at the source employer is not based on an entry-level position.

Enter the wage rate that is not based on an entry-level position for the job or contract identified.

Provide the reasoning or evidence that supports the conclusion that the wage rate is not based on an entry-level position for the job or contract identified.

Check this box if it was not practical to conduct a prevailing wage survey for the job or contract identified.

Provide the prevailing wage as provided by the source for the job or contract identified.

Specify any alternative data source used for determining the wage rate for the job or contract identified.

Indicate how frequently the employer conducts work measurements or time studies for each worker with a disability who is paid an hourly subminimum wage.

Enter the full name of the first worker with a disability.

Enter the full name of the second worker with a disability.

Enter the full name of the third worker with a disability.

Enter the full name of the fourth worker with a disability.

Enter the full name of the fifth worker with a disability.

Enter the full name of the sixth worker with a disability.

Enter the full name of the seventh worker with a disability.

Enter the full name of the eighth worker with a disability.

Enter the full name of the ninth worker with a disability.

Enter the full name of the tenth worker with a disability.

Indicate Yes (Y), No (N), or Not Reported (NR) for the first worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the second worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the third worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the fourth worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the fifth worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the sixth worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the seventh worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the eighth worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the ninth worker's status regarding a specific condition or requirement.

Indicate Yes (Y), No (N), or Not Reported (NR) for the tenth worker's status regarding a specific condition or requirement.

Enter the number of workers with disabilities paid subminimum wages at a hospital or residential care facility during the specified time period.

Enter the number of workers with disabilities paid subminimum wages at a business establishment during the specified time period.

Enter the number of workers with disabilities paid subminimum wages in the School Work Experience Program (SWEP) during the specified time period.

Enter the number of workers with disabilities paid subminimum wages in a Community Rehabilitation Program (Work Center) during the specified time period.