DT1929 Weekly Payroll Report - DOA Home



|STATE OF WISCONSIN |[pic] |Mailing Address: P. O. Box 7866, Madison, WI 53707-7866 |

|DEPARTMENT OF ADMINISTRATION | |STREET ADDRESS: 101 E. WILSON STREET, 7TH FLOOR, MADISON, WI 53703 |

|Division of Facilities Development (DFD) | |PHONE: 608 / 266-2731; FAX: 608 / 267-2710 |

|DOA-4184 (R10/2012) | |[pic] |

|Adapted from: | | |

|US Dept. of Labor, Form WH-347 (29 CFR 5.5(1)(3)) | | |

CONTRACTOR WEEKLY PAYROLL REPORT

The weekly submittal of this form is required by 29 CFR Part 3. * Full name, address, and social security number must appear on the first payroll on which the employee’s name appears.

The social security number is collected for payroll purposes.

** Fringe benefit details MUST be reported on a supplementary page. *** Include private work. **** If Operating Engineer or Laborer, include class of equipment or skill level of laborer.

|Payroll # |Employer Name |State Project ID |Federal Project ID |County |Payroll Period Week |Sheet # |

|      |      |      |      |      |Ending |      |

| |Prime Contractor Subcontractor Hired By:       | | | |      | |

Enter information below on every individual that you employed on this project during the payroll report period.* |DAILY HOURS WORKED

S = Straight Time O = Overtime |TOTAL WEEKLY HOURS

WORKED |(A)

BASIC

HOURLY

RATE |(B) BENEFITS **

HOURLY RATE |(A) + (B)

TOTAL HOURLY

RATE |PROJECT

WAGES |FICA |FED WH |ST WH |OTHER

(Specify) |NET

PAID |CHECK

# | | | | | |FUND

PAYMENT |CASH

PAYMENT | |GROSS

WAGES | | | | | | | | | |SU |M |TU |W |TH |F |SA | | | | | | | | | | | | | |Name      

Address      

City, State, ZIP Code      

S.S. #      

Trade/Craft ****      

Apprentice Yes No |REFERENCED PROJECT | | |

| | | | | | | | | | | |S |      |      |      |      |      |      |      |      |$      |$      |$      |$      | | | | | | | | | |O |      |      |      |      |      |      |      |      |$      |$      |$      |$      |$      | | | | | | | | |OTHER PROJECTS *** | | |$      |$      |$      |$      |$      |$      |      | | |S | |      | | | | | | | | | | | | | |O | |      | | | | | | | | | | | | |Name      

Address      

City, State, ZIP Code      

S.S. #      

Trade/Craft ****      

Apprentice Yes No |REFERENCED PROJECT | | | | | | | | | | | | | | |S |      |      |      |      |      |      |      |      |$      |$      |$      |$      | | | | | | | | | |O |      |      |      |      |      |      |      |      |$      |$      |$      |$      |$      | | | | | | | | |OTHER PROJECTS *** | | |$      |$      |$      |$      |$      |$      |      | | |S | |      | | | | | | | | | | | | | |O | |      | | | | | | | | | | | | |Name      

Address      

City, State, ZIP Code      

S.S. #      

Trade/Craft ****      

Apprentice Yes No |REFERENCED PROJECT | | | | | | | | | | | | | | |S |      |      |      |      |      |      |      |      |$      |$      |$      |$      | | | | | | | | | |O |      |      |      |      |      |      |      |      |$      |$      |$      |$      |$      | | | | | | | | |OTHER PROJECTS *** | | |$      |$      |$      |$      |$      |$      |      | | |S | |      | | | | | | | | | | | | | |O | |      | | | | | | | | | | | | |Name      

Address      

City, State, ZIP Code      

S.S. #      

Trade/Craft ****      

Apprentice Yes No |REFERENCED PROJECT | | | | | | | | | | | | | | |S |      |      |      |      |      |      |      |      |$      |$      |$      |$      | | | | | | | | | |O |      |      |      |      |      |      |      |      |$      |$      |$      |$      |$      | | | | | | | | |OTHER PROJECTS *** | | |$      |$      |$      |$      |$      |$      |      | | |S | |      | | | | | | | | | | | | | |O | |      | | | | | | | | | | | | |Name      

Address      

City, State, ZIP Code      

S.S. #      

Trade/Craft ****      

Apprentice Yes No |REFERENCED PROJECT | | | | | | | | | | | | | | |S |      |      |      |      |      |      |      |      |$      |$      |$      |$      | | | | | | | | | |O |      |      |      |      |      |      |      |      |$      |$      |$      |$      |$      | | | | | | | | |OTHER PROJECTS *** | | |$      |$      |$      |$      |$      |$      |      | | |S | |      | | | | | | | | | | | | | |O | |      | | | | | | | | | | | | |

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