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Wage Determination No.: Enter the wage determination number(s) and revision number(s) included in the covered <br />contract and relevant to the submitted certified payroll form (e.g., if there are multiple wage determinations applicable to <br />the project, please list all wage determinations that applied to the work performed by the workers in this pay period). <br />Week Ending Date: Enter the workweek ending date for this pay period. <br />Prime Contractor’s/Subcontractor’s Business Address: Enter the company’s full business address. <br />Column 1A – Worker Entry No.: Beginning with the number “1”, enter each worker’s entry number (e.g., entry in row 2 may <br />be 2, entry in row 3 may be 3, etc. If reporting more than 8 entries, row 1 on page 2 may be entry 9 and row 1 on page 3 <br />may be entry 17, etc.). If a worker works in more than one labor classification during the course of the week, the <br />contractor should show the number of hours the worker worked in each classification using separate rows. In such <br />circumstances, the same worker entry number should be used on each row associated with the worker. <br />Column 1B – Worker Last Name: Self-explanatory. <br />Column 1C – Worker First Name: Self-explanatory. <br />Column 1D – Worker Middle Initial: Self-explanatory. <br /> <br />Column 1E – Worker Identifying No.: Enter each worker’s individual identifying number (e.g., last four digits of the <br />worker’s social security number or any number specific to the individual worker) on each weekly certified payroll <br />submitted. Note: workers’ full Social Security numbers must not be included. <br />Column 2 – Journeyworker / Registered Apprentice: Enter “J” if the worker is a journeyworker or “RA” if the worker is a <br />registered apprentice in an apprenticeship program approved by DOL’s Office of Apprenticeship (OA) or a State <br />Apprenticeship Agency (SAA). For registered apprentices, also list their level of progression within the approved program. <br />Column 3 – Labor Classification: List the labor classification for the work actually performed by each worker. Labor <br />classifications are found in the applicable Davis-Bacon wage determination(s) that are included in the contract for this <br />project. If the wage determination(s) does not include a labor classification for work that a worker has performed on this <br />contract, contact the Contracting Officer or Agency representative immediately. <br />Docusign Envelope ID: CF064D56-F89A-8651-8229-D168AFF8B909