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Blank U.S. DoL Form

The U.S. Department of Labor (DoL) form is a crucial document used for various employment-related purposes, including wage and hour claims and workplace safety reports. Understanding how to properly fill out this form can streamline processes and ensure compliance with federal regulations. By being informed, you can navigate the complexities of labor laws with confidence.

Outline

The U.S. Department of Labor (DoL) plays a crucial role in ensuring fair labor practices and protecting the rights of workers across the nation. One essential tool in this mission is the DoL form, which serves various purposes depending on the specific context in which it is used. From reporting workplace injuries to filing wage complaints, this form facilitates communication between employees, employers, and government agencies. It often includes sections for personal information, details about the workplace incident or issue, and any relevant supporting documentation. Understanding how to properly fill out and submit this form can significantly impact the outcome of a labor-related issue, making it vital for workers to be informed about its requirements. Moreover, the DoL form not only helps in documenting grievances but also assists in tracking compliance with labor laws, ensuring that workers are treated fairly and justly in their employment. By navigating the complexities of this form, individuals can take a proactive step toward advocating for their rights and fostering a safer, more equitable workplace environment.

Sample - U.S. DoL Form

U.S. Department of Labor Davis-Bacon and Related Acts Weekly Certiﬁed Payroll Form


Wage and Hour Division	(For Contractor’s Optional Use; See Instructions at www.dol.gov/whd/forms/wh347instr.htm)
	Unless otherwise noted, the information requested is speciﬁc to the named project below.
	Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.
 SUBMISSION OF FINAL DBRA CERTIFIED PAYROLL FORM		 PRIME CONTRACTOR	 SUBCONTRACTOR

Rev. January 2025

OMB No.: 1235-0008

Expires: 01/31/2028

PROJECT NAME	PROJECT NO. or CONTRACT NO.	CERTIFIED PAYROLL NO.	PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS NAME
PROJECT LOCATION	WAGE DETERMINATION NO.	WEEK ENDING DATE	PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS ADDRESS

(1A)

(1B)

(1C)

(1D)

(1E)

(2)

(3)

(4)

(5)

(6A)

(6B)

(6C)

(7A)

(7B)

(8)

NO.ENTRYWORKER

NAMELASTWORKER

FIRSTWORKER NAME

MIDDLEWORKER INITIAL

WORKER NO.IDENTIFYING

JOURNEYWORKER(J)

REGISTERD(RA)

APPRENTICE

LABOR CLASSIFICATION

TIMESTRAIGHT=ST

OVERTIME=OT

(TOP) DAYS OF WORK WEEK

HOURSTOTAL WEEKFORWORKED

RATEWAGEHOURLY ANDSTFORPAIDOT

FRINGETOTAL CREDITBENEFIT

LIEUINPAYMENTOF BENEFITSFRINGE

EARNEDAMTGROSS

EARNEDAMTGROSS WORKALLFOR

DEDUCTIONS FOR ALL WORK

(BOTTOM) DATES

-WITHTAX HOLDINGS

FICA

(MUSTOTHER

SEESPECIFY, INSTRUCTIONS)

TOTAL DEDUCTIONS

HOURS WORKED

EACH DAY

(9)

FOR ALL WORK

NET PAY TO WORKER

While use of Form WH-347 itself is optional, covered contractors and subcontractors performing work on Federal or federally assisted construction contracts are required by the DBRA regulations and the contract clauses to submit payroll information on a weekly basis. The Copeland Act (40 U.S.C. § 3145) requires contractors and subcontractors performing work on Federal or federally ﬁnanced construction contracts to, on a weekly basis, “furnish a statement on the wages paid each employee during the prior week.” U.S. Department of Labor (DOL) Regulations at 29 C.F.R. § 5.5(a)(3)(ii) require contractors and subcontractors to submit weekly certiﬁed payrolls to the appropriate Federal agency if the agency is a party to the contract (or, if the agency is not such a party, to the applicant, sponsor, owner, or other entity, as the case may be, that maintains such records, for transmission to the Federal agency). Each certiﬁed payroll must be accompanied by a signed “Statement of Compliance” (e.g., page 2 of the WH-347 or another document with identical wording) indicating that the certiﬁed payrolls are accurate and complete, and that each laborer or mechanic has been paid not less than the required Davis-Bacon prevailing wage rate(s) (including any fringe beneﬁts) for the work performed. DOL and contracting agencies receiving this information review the information to determine whether workers have received legally required wages and fringe beneﬁts.

Public Burden Statement

We estimate that it will take an average of 55 minutes to complete this collection, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. If you have any comments regarding these estimates or any other aspect of this collection, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S3502,
200 Constitution Avenue, N.W. Washington, D.C. 20210	(over)

PROJECT NAME	PROJECT NO. or CONTRACT NO.	PAYROLL NO.	PRIME CONTRACTOR’S/SUBCONTRACTOR’S BUSINESS NAME
PROJECT LOCATION		WEEK ENDING DATE	CERTIFYING OFFICIAL’s NAME AND TITLE

I paid or supervised the payment of the laborers or mechanics working on the above project during the stated time period. I certify the following:

The payroll information submitted with this statement is correct and complete for the above project during the above period, and the wage and fringe beneﬁt rates paid to the workers,

including credit taken for the reasonably anticipated costs of a bona ﬁde fringe beneﬁt plan, fund or program, are not less than the applicable wage and fringe beneﬁts rates for the classiﬁcation(s) of work actually performed, as speciﬁed in the wage determination(s) incorporated into the contract.

All regular payrolls and all other basic records that the contractor is required to maintain for this payroll period are complete and accurate and will be made available upon request from the

agency or the Department of Labor.

The classiﬁcations reported for each laborer or mechanic are the classiﬁcation(s) of work that each worker actually performed.

Any workers paid as apprentices during the above period are duly registered in a bona ﬁde apprenticeship program registered with the Oﬃce of Apprenticeship, Employment and Training

Administration, United States Department of Labor (“OA”), or a State Apprenticeship Agency (“SAA”) recognized by Department of Labor. I have veriﬁed the registered apprenticeship program information provided below as accurate and applicable to any apprentices identiﬁed on page 1 of this form.

APPRENTICESHIP PROGRAM NAME	REGISTERED		NAME OF LABOR CLASSIFICATION
	 OA	 SAA
	 OA	 SAA
	 OA	 SAA

Fringe beneﬁts have been paid in cash and/or to bona ﬁde fringe beneﬁt plans, funds, or programs. Where the contractor is claiming an hourly credit for their contributions to or reasonably

anticipated costs of a bona ﬁde fringe beneﬁt plan, fund, or program, provide plan information and the hourly credit claimed for each worker listed on the previous page of this form.

HOURLY CREDIT FOR FRINGE BENEFITS

If an amount is listed in (6B) on the ﬁrst page of this certiﬁed payroll form, enter the hourly credit claimed under each plan name, type and number for each worker and check whether the plan is funded or unfunded.

FB NAME

TOTAL

FB TYPE

NAME OF WORKER

HOURLY

PLAN NO.

CREDIT

 Funded

 Unfunded

 Funded

 Unfunded

 Funded

 Unfunded

 Funded

 Unfunded

 Funded

 Unfunded

 Funded

 Unfunded

Hourly Credit

Hrly Credit



All workers on the project have been paid the full weekly wages earned, and no rebates or deductions have been or will be made either directly or indirectly, other than permissible

deductions as deﬁned in 29 CFR part 3.

ADDITIONAL REMARKS

SIGNATURE OF CERTIFYING OFFICIAL

DATE

TELEPHONE NUMBER

EMAIL ADDRESS

( __ __ __ ) __ __ __ – __ __ __ __

THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION (SEE SECTION 1001 OF TITLE 18 AND SECTION 3729 OF TITLE 31 OF THE UNITED STATES CODE), AS WELL AS DEBARMENT FROM FUTURE FEDERAL AND FEDERALLY-ASSISTED CONTRACTS. INFORMATION REPORTED IN CERTIFIED PAYROLLS MAY BE SUBJECT TO DISCLOSURE IN RESPONSE TO A FREEDOM OF INFORMATION ACT REQUEST.

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Form Information

Fact Name	Description
Purpose	The U.S. Department of Labor (DoL) forms are designed to collect information related to employment, labor standards, and workplace safety.
Types of Forms	Various forms exist, including those for wage and hour claims, workplace injuries, and employee benefits.
Filing Requirements	Individuals and businesses must complete specific forms to comply with federal labor laws and regulations.
State-Specific Forms	Many states have their own forms that align with state labor laws, such as California's Labor Code and New York's Labor Law.
Submission Process	Forms can typically be submitted online, by mail, or in person, depending on the specific requirements of the form.
Confidentiality	Information provided on these forms is generally treated as confidential, protecting the privacy of the individuals involved.
Assistance Available	Resources and assistance are available through the DoL website and local labor offices for those needing help with form completion.

Detailed Guide for Filling Out U.S. DoL

Once you have the U.S. Department of Labor (DoL) form in hand, it’s time to get started on filling it out. This process requires careful attention to detail to ensure accuracy. Follow these steps closely to complete the form correctly.

Begin by reading the instructions that accompany the form. Understanding the requirements will make the process smoother.
Gather all necessary information and documents you will need to complete the form. This may include personal identification, employment details, and any relevant financial information.
Start filling in your personal information at the top of the form. This typically includes your name, address, and contact information.
Proceed to the section that requests details about your employment. Provide accurate information regarding your job title, employer’s name, and employment dates.
Fill in any additional sections that apply to your situation. Be sure to answer all questions thoroughly and honestly.
If the form requires signatures, ensure that you sign and date it at the appropriate places. A missing signature can delay processing.
Review your completed form for any errors or omissions. It’s important to double-check all information before submission.
Make a copy of the filled-out form for your records. This can be helpful for future reference or in case of any issues.
Submit the form according to the instructions provided. This may involve mailing it to a specific address or submitting it online.

After submitting the form, you may need to wait for a response. Keep track of any confirmation numbers or receipts you receive. This will help you follow up if necessary.

Obtain Answers on U.S. DoL

What is the U.S. Department of Labor (DoL) form?

The U.S. Department of Labor (DoL) form refers to various forms used by the DoL to collect information related to labor laws, employment statistics, and worker rights. These forms are essential for ensuring compliance with federal labor regulations and may include applications, reports, and claims related to wage and hour laws, workplace safety, and employee benefits.
Who needs to fill out a U.S. DoL form?

Different stakeholders may need to complete these forms. Employers, employees, and organizations involved in labor relations may be required to submit specific forms. For example, employers may need to file forms related to wage determinations, while employees might need to submit forms to claim unpaid wages or report violations of labor laws.
How do I obtain a U.S. DoL form?

U.S. DoL forms can typically be obtained from the official Department of Labor website. The site provides downloadable versions of forms, along with instructions on how to complete them. Additionally, local DoL offices may have printed forms available for those who prefer in-person assistance.
What is the process for submitting a U.S. DoL form?

Once a form is completed, it must be submitted according to the instructions provided. Some forms can be submitted online through the DoL’s website, while others may require mailing or faxing to a specific address. It is crucial to ensure that the form is sent to the correct department to avoid delays in processing.
What happens after I submit a U.S. DoL form?

After submission, the relevant department will review the form. Depending on the type of form, you may receive a confirmation of receipt, and further communication may follow. If additional information is required, the DoL will contact you. It’s advisable to keep a copy of the submitted form for your records.
Are there deadlines for submitting U.S. DoL forms?

Yes, many U.S. DoL forms have specific deadlines. These deadlines can vary based on the type of form and the circumstances surrounding it. For instance, wage claims often have a statute of limitations that requires timely submission. It is important to check the instructions for each form to ensure compliance with all deadlines.
What should I do if I make a mistake on a U.S. DoL form?

If an error is discovered after submission, it is important to correct it as soon as possible. Depending on the form, you may need to submit a corrected version or provide an explanation of the error to the DoL. Contacting the appropriate department directly can provide guidance on how to proceed with corrections.

Common mistakes

Completing the U.S. Department of Labor (DoL) form can be a straightforward process, but many individuals encounter pitfalls that can complicate their applications. One common mistake is providing incomplete information. When sections of the form are left blank, it can lead to delays or even denials. Every detail matters, and ensuring that all required fields are filled out completely is essential for a smooth application process.

Another frequent error is failing to double-check for accuracy. Simple typos or miscalculations can cause significant issues. For instance, incorrect Social Security numbers or misspelled names can lead to confusion or complications in processing the form. Taking the time to review the information before submission can save individuals from unnecessary headaches later on.

Additionally, misunderstanding the instructions can lead to improper completion of the form. Each section has specific requirements, and overlooking these can result in misinterpretation of what is needed. It is crucial to read all instructions carefully and, if necessary, seek clarification on any points that seem unclear. This proactive approach can help ensure that the form is filled out correctly.

Finally, many people neglect to keep a copy of their submitted form. This oversight can be problematic if there are questions or follow-ups regarding the application. Having a record allows individuals to reference their original submission, making it easier to respond to any inquiries from the DoL. Keeping organized documentation is a simple yet effective way to streamline the process and avoid potential complications.

Documents used along the form

When dealing with labor-related issues, several forms and documents may accompany the U.S. Department of Labor (DoL) form. Each of these documents serves a specific purpose and can be crucial in ensuring compliance with labor laws and regulations. Understanding these forms can help streamline processes and protect your rights.

Employment Application: This document is often the first step in the hiring process. It collects essential information from job candidates, such as their work history, education, and references.
W-4 Form: This form is filled out by employees to inform their employer of their tax withholding preferences. It helps ensure the correct amount of federal income tax is withheld from their paychecks.
Employee Handbook: This document outlines company policies, procedures, and expectations for employees. It serves as a guide to workplace conduct and benefits.
Non-Disclosure Agreement (NDA): An NDA protects sensitive company information. Employees sign this document to agree not to disclose proprietary information during and after their employment.
Performance Review Form: Used by employers to evaluate an employee's job performance, this form often includes criteria for assessment and space for feedback and goal setting.
Termination Letter: This formal document communicates the end of employment. It outlines the reasons for termination and any final pay or benefits due to the employee.
Time-Off Request Form: Employees use this form to request time off for various reasons, such as vacation or medical leave. It helps employers manage staffing and track employee absences.
Incident Report Form: This document is used to record details of workplace incidents, such as accidents or injuries. It is essential for documenting events and may be necessary for workers' compensation claims.

Familiarity with these forms can greatly enhance your understanding of workplace rights and responsibilities. By ensuring that all necessary documents are completed and submitted correctly, you can help create a smoother work environment for everyone involved.

Similar forms

The U.S. Department of Labor (DoL) form serves specific purposes related to labor and employment. Several other documents share similarities in function and intent. Here are four such documents:

Employment Verification Form: This document is used by employers to confirm an employee's job status, including their role and duration of employment. Like the DoL form, it helps establish the legitimacy of employment claims.
W-2 Form: Issued by employers, the W-2 form reports an employee's annual wages and the taxes withheld. Similar to the DoL form, it provides essential information for both employees and government agencies regarding income and employment status.
Form I-9: This form verifies an employee's identity and eligibility to work in the United States. It serves a similar purpose to the DoL form by ensuring compliance with employment regulations and confirming that workers meet legal requirements.
Labor Condition Application (LCA): Required for certain visa applications, the LCA outlines the working conditions for foreign workers. This document is comparable to the DoL form in that it addresses employment conditions and seeks to protect worker rights.

Dos and Don'ts

When filling out the U.S. Department of Labor (DoL) form, it is important to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do:

Do read the instructions carefully before starting.
Do provide accurate and truthful information.
Do double-check your entries for errors.
Do keep a copy of the completed form for your records.
Don't leave any required fields blank.
Don't submit the form without reviewing it first.
Don't use abbreviations or slang that may cause confusion.

Misconceptions

When dealing with the U.S. Department of Labor (DoL) forms, several misconceptions can lead to confusion. Understanding these can help ensure proper compliance and avoid unnecessary complications. Here are five common misconceptions:

All DoL forms are the same.
This is not true. The Department of Labor has various forms tailored to different purposes, such as wage and hour issues, workplace safety, and employee benefits. Each form serves a specific function and must be filled out accordingly.
Filing a DoL form is optional.
Many believe that submitting forms to the DoL is not mandatory. However, in many cases, filing is required by law. Employers must comply with regulations to avoid penalties or legal issues.
DoL forms can be submitted at any time.
While some forms can be submitted at any time, others have specific deadlines. Missing these deadlines can affect rights and benefits, so it is important to be aware of the timelines associated with each form.
Filling out a DoL form is straightforward and doesn't require guidance.
Many individuals assume they can easily complete forms without assistance. However, some forms can be complex. Seeking help from knowledgeable sources can ensure that the forms are completed accurately.
Once a form is submitted, it cannot be changed.
This misconception can lead to frustration. In reality, many forms can be amended after submission if errors are discovered. Knowing the process for making changes can be beneficial.

Understanding these misconceptions can help individuals navigate the requirements of the U.S. Department of Labor more effectively. Being informed is the first step toward compliance and success.

Key takeaways

When filling out and using the U.S. Department of Labor (DoL) form, consider the following key takeaways:

Accuracy is crucial. Ensure all information is correct to avoid delays in processing.
Follow the instructions carefully. Each section of the form has specific requirements that must be met.
Keep copies of your submissions. Retaining a copy of the completed form is important for your records.
Submit on time. Be aware of deadlines to ensure compliance with regulations.