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U.S. Department of Labor PAYROLL 94 <br /> Wage and Hour Division (For Contractor's optional Use;See Instructions at www.dol.govlwhdlforms/wh347instr.htm) U.S.Wage and Hour Division <br /> Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev.Dec.2008 <br /> NAME OF CONTRACTOR OR SUBCONTRACTOR[3 ADDRESS OMB No.:1215-0149 <br /> I Expires: 12/31/2011 <br /> PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECTOR CONTRACT <br /> (2) (3) (4)DAY AND DATE (7) (9) <br /> (8) <br /> DEDUCTIONS <br /> I I I I I I NET <br /> NAME AND INDIVIDUAL IDENTIFYING NUMBER bi GROSS WITH- WAGES <br /> (e.g.,LAST FOUR DIGITS OF SOCIAL SECURITY WORK 0 TOTALI RATE AMOUNT HOLDING TOTAL PAID <br /> NUMBER)OF WORKER 93: CLASSIFICATION HOURS WORKED EACH DAY HOUR SI OF PAY EARNED FICA TAX OTHER—DEDUCTIONS FOR WEEK <br /> 0 <br /> 0 <br /> a <br /> 0 <br /> ES <br /> l I I <br /> a <br /> 0 <br /> ---------- a <br /> 0 <br /> s <br /> 0 <br /> a <br /> 0 <br /> a <br /> While completion of Form WH-347 Is optional,it Is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the Information collection contained In 29 C.F.R.§§3.3,5.5(a).The Copeland Act <br /> (40 U.S.C.§3145)contractors and subcontractors performing work on Federally financed or assisted construction contracts to"furnish weekly a statement with respect to the wages paid each employee during the preceding week.*U.S.Department of Labor(DOL)regulations at <br /> 29 C.F.R.§5.5(a)(3)01)require contractors to submit weekly a copy of all payrolls to the Federal agency contracting for or financing the construction project,accompanied by a signed"Statement of Compliance*Indicating that the payrolls are correct and complete and that each taborer <br /> or mechanic has been paid not less than the proper Davis-Bacon prevailing wage rate for the work performed.DOIL and federal contracting agencies receiving this information review the Information to determine that employees have received legally required wages and fringe benefits. <br /> Public Burden Statement <br /> We estimate that is will take an average of 55 minutes to complete this collection,including time for reviewing Instructions,searching eidsfing data sources,gathering and maintaining the data needed,and complefing and reviewing the collection ofinforrnation.If you have <br /> 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. <br /> c <br /> Washington,D.C.20210 <br /> (over) <br />