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

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

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

If the employer has previously held a 14(c) certificate, list the most recently held main establishment certificate number.

Check this box if this is an initial application for a 14(c) certificate.

Check this box if this is a renewal application for a 14(c) certificate.

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

Check this box if the application is for a Hospital/Residential Care Facility (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.

Provide the signature of the person completing the form.

Enter the date when the form is being completed in the format mm/dd/yyyy.

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.

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.

Provide the month (as a number) when the employer's most recently completed fiscal quarter ended.

Provide the day (as a number) when the employer's most recently completed fiscal quarter ended.

Provide the year when the employer's most recently completed fiscal quarter ended.

Enter the legal name of the employer applying for the 14(c) certificate.

Enter the trade name of the employer if it is different from the legal name.

List any prior names of the employer if they have changed since the last application.

Enter the street address of the employer's location.

Enter the mailing address if it is different from the street address.

Enter the ZIP code for the employer's location.

Enter the state where the employer is located.

Enter the county where the employer is located.

Enter the city where the employer is located.

Enter the first and last name, and title of the contact person for the application.

Enter the email address of the application contact person.

Enter the fax number for the employer.

Enter the telephone number for the employer.

Enter the Federal Employer Identification Number (EIN) for the employer.

Indicate whether the employer is a local or State educational agency by checking 'Yes'.

Indicate whether the employer is a local or State educational agency by checking 'No'.

Enter the total number of establishments and work sites, including main, branch, off-site, or school work experience program sites, to be covered by this certificate.

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 number of workers with disabilities employed at subminimum wages during the most recently completed fiscal quarter.

Enter the number of workers with disabilities employed at subminimum wages in a Hospital or Residential Care Facility.

Enter the number of workers with disabilities employed at subminimum wages in a Business Establishment.

Enter the number of workers with disabilities employed at subminimum wages in a School Work Experience Program (SWEP).

Enter the number of workers with disabilities employed at subminimum wages in a Community Rehabilitation Program (Work Center).

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.

Indicate whether the employer manufactures items for the Federal Government under the PCA by checking 'No'.

Indicate whether the employer manufactures items for the Federal Government under the PCA by checking 'Yes'.

Indicate whether the employer currently holds any contracts covered by the SCA by checking 'Yes'.

Indicate whether the employer currently holds any contracts covered by the SCA by checking 'No'.

Indicate if the employer does not currently hold any SCA-covered contracts but intends to within the next two years.

If the employer holds SCA-covered contracts, enter the total number of such contracts under which workers with disabilities are employed and earning subminimum wages.

Indicate if the employer has entered into a contract for services or concessions with the Federal Government since January 1, 2015, that may be subject to Executive Order 13658.

Indicate if the employer has not entered into a contract for services or concessions with the Federal Government since January 1, 2015, that may be subject to Executive Order 13658.

Indicate if the employer has not yet entered into a contract for services or concessions with the Federal Government but intends to within the next two years, which may be subject to Executive Order 13658.

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.

Check this box if mail should be sent to the parent organization instead of the employer's address.

Specify the status of the organization if it does not fit into the provided categories.

Check this box if the organization is a public entity (state or local government).

Check this box if the organization is a private, not-for-profit entity.

Check this box if the organization is a private, for-profit entity.

Check this box if the organization's status is 'Other'.

Enter the legal name of the parent organization, if applicable.

Enter the trade name of the parent organization, if applicable.

Enter the mailing address of the parent organization.

Enter the ZIP code for the parent organization's location.

Enter the state where the parent organization is located.

Enter the county where the parent organization is located.

Enter the city where the parent organization is located.

Enter the first and last name of the person completing the form. This should be printed or typed.

Enter the job title of the person completing the form.

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 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.