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_.._ ..,.r....... 0 <br />Office of Labor Relations (Exp. 09/..30/200) <br />Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing <br />Instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. <br />The information Is considered non -sensitive and does not require special protection. This information Is required to obtain benefits. This agency <br />may not collect this Information, and you are not required to complete this form, unless It displays a currentiyvalld OMB control number. <br />Employers engaged on HUD -assisted construction projects subject to Davis -Bacon wage requirements must pay no less than the wages <br />determined to be prevailing by the Secretary of Labor to all laborers and mechanics engaged on the construction work. On occasion, the <br />applicable Davla-Bacon wage decision does not contain all of the work classifications and wage rates needed to complete the construction work. <br />This Information collection facilitates the addition of needed work classifications and wage rates for the construction work involved. This form is <br />used by HUD and local agencies administering HUD programs to report employer requests) for additional classification and wage rates so that <br />an appropriate wage rate can be approved by the Depadment of Labor for the construction work. This Information collection is required by <br />Department of Labor regulations at 29 CFR 5.5. While no assurances of confidentiality are pledged to respondents, HUD generally discloses <br />these data only In response to a Freedom of Information request. <br />Instructions <br />General: <br />Contractors/Employers: Do not need to complete this form. Submit a written, signed request to the responsible contracting <br />agency naming the work classifications and the wage rates, including any fringe benefits, that are proposed. <br />Local Agency Staff: Complete Items 2 through 10. Submit one copy of this form to the responsible HUD Labor Relations Office <br />with a copy of the applicable Davis -Bacon wage decision and the written request from the employer naming the work <br />classifications and wage rates that are proposed. (The employer's request must be made in writing and must be signed.) <br />1. For HUD or State CDBG Office use. Enter the name and address of HUD Office (or State CDBG office) submitting the <br />report and to which the DOL reply should be sent. <br />2. Enter the name and number of the project or contract involved. <br />3. Enter the location of the project involved: city, county and state. <br />4. Describe the construction involved, e.g., new construction or rehabilitation, number and type of buildings, number of stories, <br />number of units (as applicable). For example, New construction: 3-4-story buildings; 120 units. <br />6. Enter the character of construction as defined by DOL for Davis -Bacon prevailing wage rate purposes. <br />6. Enter the number of the Davis -Bacon wage decision applicable to the construction work. Include the number of wage <br />decision modifications (If any) applicable to the work. <br />7. Enter the effective date of the wage decision for the project. (See DOL regulations at 29 CFR 1.6.) <br />S. Enter the work classifications and corresponding hourly basic wage rates and fringe benefit rates (if any) requested. <br />9. Self-explanatory. <br />10, If the requesting employer is not the prime contractor, enter the name and address of the subcontractor/employer making <br />the request. <br />Remainder of Farm; HUD Labor Relations/State CDBG use. <br />HUD Labor Relations/State CDBG Staff: Evaluate the employer's request against the criteria for approval (see DOL <br />Regulations, 29 CFR Part 5, and related contract labor standards provisions). The criteria are reflected in "checklist" form to <br />ensure that each factor Is considered and to ensure that supporting documentation, Including a copy of the applicable wage <br />decision, Is attached. Check the box next to each criterion that Is met; do not check the box next to any criterion that Is not met. <br />If the request meets all criteria, check the appropriate box, enter the name and telephone number of the HUD/State CDBG <br />agency representative, and sign and date the form. Submit one copy of the completed form to the DOL with a copy of the <br />applicable Davis -Bacon wage decision and the written request from the employer Involved. <br />If the request fails to pass all criteria, check the appropriate box, enter agency contact information, and sign and date the form. <br />Submit one copy of the completed form to the DOL with a copy of the applicable Davis -Bacon wage decision, the written request <br />from the employer Involved, and a cover letter explaining how the employer's request failed to meet one or more of the criteria. <br />Submission of Report <br />Completed forms shall be sent to: Branch of Construction Wage Determinations, U.S. Department of Labor, 200 Constitution <br />Avenue, NW, Room S-3014, Washington, DC 20210. <br />HUD-42304 (e-03) PREVIOUS EDITION IS OB$OLEM <br />