[OFFICIAL FORM] U.S. Department of Labor · Wage & Hour Division · OMB No. 1235-0008
Form WH-347 Certified Payroll Schedule & Statement
Draft for review
Awaiting input
Select a sample scenario on the left or complete Steps 1.1-1.3 -- the worksheet updates live as you type.
Part A Rate schedule per hour
| Component | Required | Paid | Shortfall |
|---|---|---|---|
| Basic hourly rate | -- | -- | -- |
| Fringe benefits | -- | -- | -- |
| Hourly package | -- | -- | -- |
| Overtime cash rate | -- | -- | -- |
Part B Hours and earnings
| Line | Hours | Rate | Amount |
|---|---|---|---|
| Straight time | -- | -- | -- |
| Overtime | -- | -- | -- |
| Gross pay | -- | n/a | -- |
| Plan fringe, outside gross | -- | -- | -- |
Part C Deductions and net pay
| Item | Amount |
|---|---|
| Federal income tax | -- |
| FICA (Social Security + Medicare) | -- |
| State income tax | -- |
| Other deductions | -- |
| Total deductions | -- |
| Net pay | -- |
| Back-wage restitution owed | -- |
Part D Calculation audit trail
- Package test--
- Fringe source--
- Overtime rate--
- Gross build-up--
- Net after deductions--
- Back-wage basis--
Part E Compliance checks
| Check | Result | Detail |
|---|---|---|
| Cash rate covers prevailing base | Pending | Awaiting a complete rate entry. |
| Fringe obligation met by plan or cash | Pending | Fringe test runs after rates are entered. |
| Overtime split at 40 straight-time hours | Pending | Hours test runs after hours are entered. |
| Plan credit within the fringe requirement | Pending | Credit test runs after the plan credit is entered. |
| Deductions within gross pay | Pending | Deduction test runs once gross pay exists. |
Part F Certification title block
Signature of authorized official
Name and title
Date signed
Engineering stamp gate
The official, watermark-free certification sheet and saved project profiles come with Pro at $29 per month.
Pro stamp active on this device