DBRA Certified Payroll 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.                                                                                                                                    Rev. January 2025
                                                                                                                                                                                                                                                                                                                         OMB No.: 1235-0008
 SUBMISSION OF FINAL DBRA CERTIFIED PAYROLL FORM                                                                                                                             PRIME CONTRACTOR                                                                               SUBCONTRACTOR                             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)                                (9)

                                                                                                                                                   (TOP) DAYS OF WORK WEEK                                                                                                                       DEDUCTIONS FOR ALL WORK
                     WORKER LAST NAME




                                                                                         (J) JOURNEYWORKER




                                                                                                                                                                                                                                                                                                                                                  NET PAY TO WORKER
                                                                                                                                                                                                                                                          GROSS AMT EARNED

                                                                                                                                                                                                                                                                             GROSS AMT EARNED
                                                                                                                                                                                                                                     PAYMENT IN LIEU OF
                                                                                                                                                                                               PAID FOR ST AND OT
                                                                                                                                                                                               HOURLY WAGE RATE
  WORKER ENTRY NO.




                                                                                                                              ST = STRAIGHT TIME




                                                                                                                                                                             WORKED FOR WEEK
                                                                                                                                                        (BOTTOM) DATES
                                                       WORKER MIDDLE




                                                                                                                                                                                                                                     FRINGE BENEFITS
                                                                       IDENTIFYING NO.




                                                                                                                                                                                                                    BENEFIT CREDIT
                                                                                                             CLASSIFICATION
                                                                                         (RA) REGISTERD




                                                                                                                              OT = OVERTIME




                                                                                                                                                                                                                                                                             FOR ALL WORK




                                                                                                                                                                                                                                                                                                                                                  FOR ALL WORK
                                        WORKER FIRST




                                                                                                                                                                                                                    TOTAL FRINGE
                                                                                                                                                                             TOTAL HOURS




                                                                                                                                                                                                                                                                                                                     INSTRUCTIONS)


                                                                                                                                                                                                                                                                                                                                     DEDUCTIONS
                                                                                         APPRENTICE




                                                                                                                                                                                                                                                                                                                     OTHER (MUST
                                                                                                                                                                                                                                                                                                                     SPECIFY, SEE
                                                                                                                                                                                                                                                                                                HOLDINGS
                                                                                                                                                                                                                                                                                                TAX WITH-
                                                                       WORKER
                                                       INITIAL




                                                                                                             LABOR
                                        NAME




                                                                                                                                                                                                                                                                                                                                     TOTAL
                                                                                                                                                     HOURS WORKED




                                                                                                                                                                                                                                                                                                            FICA
                                                                                                                                                       EACH DAY
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
                                                                                                                              ST
                                                                                                                              OT
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                      FB NAME                      FB NAME                      FB NAME                      FB NAME                       FB NAME
                                                                                                                                                                                                                    TOTAL
                                  FB TYPE                      FB TYPE                      FB TYPE                      FB TYPE                      FB TYPE                       FB TYPE
         NAME OF WORKER                                                                                                                                                                                            HOURLY
                                  PLAN NO.                     PLAN NO.                     PLAN NO.                     PLAN NO.                     PLAN NO.                      PLAN NO.                       CREDIT
                                   Funded         Unfunded    Funded       Unfunded      Funded       Unfunded      Funded       Unfunded      Funded       Unfunded       Funded       Unfunded
                                             $
                                  Hourly Credit          Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          Hourly Credit $             Hourly Credit $            $
                               Hourly Credit $           Hourly Credit $          Hourly Credit $          Hourly Credit $          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.