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U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT <br />HUD FORM 4236A <br />REPORT OF ADDITIONAL CLASSIFICATION AND RATE <br />ONIBAppmval Number 001-80" <br />(Exp. 0e1swow) <br />1. FROM (name and address of requesting agency) <br />a. PROJECT NAME AND NUMBER <br />s. LOCATION OF PROJECT (City, County and State) <br />4. BRIEF DESCRIPTION OF PROJECT 5. CHARACTER OF CONSTRUCTION <br />❑ Building ❑ Residential <br />Heavy ❑ Other (specify) <br />Highway <br />6. WAGE DECISION NO. (Include modl0catlon number, if any) 7. WAGE DECISION EFFECTIVE DATE <br />❑ COPY ATTACHED <br />g, WORK CLASSIFICATION(S) HOURLY WAGE RATES <br />BASIC WAGE FRINGE BENEFIT(S) (if any) <br />9. PRIME CONTRACTOR (name, address) <br />1a. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE (name, address) <br />Check All That Apply. <br />❑ The work to be performed by the additional classifications) is not performed by a classification In the applicable wage decision. <br />❑ The proposed cleaslOcation is utilized in the area by the construction Industry. <br />rate($), Including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in <br />❑ The proposed wage <br />the wage decision. <br />The interested parties, Including the employees or their authorized representatives, agree on the classlflcatlon(s) and wage rate(s). <br />❑ <br />❑ Supporting documentation attached, including applicable wage decision. <br />Check On®: <br />El Approved, meets all criteria. DOL confirmation requested. <br />fall to most all criteria as explained In agency referral. DOL decision requested. <br />❑ One or more Classifications <br />FOR HUD USE ONLY <br />MOW <br />Agency Representative Dare Log in: <br />(Typed name and signature) <br />Log out: <br />Phone Number <br />HU0.6200A (8-08) PREVIOUS EDITION Is <br />