Form HUD-4730 Federal Labor Standards Questionnaire

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Office of Labor Relations Federal Labor Standard Questionnaire

HUD FORM 4730 OMB Approval Number 2501-0018 (Exp. xx/xx/xxxx)

Many construction projects assisted by the Department of Housing and Urban Development (HUD) are covered by federal labor standards. These standards include the payment of prevailing wage rates as determined by the Secretary of Labor, otherwise known as Davis-Bacon wage rates. In addition, many projects are covered by overtime rules that require the payment of one and one-half times the regular rate of pay for hours worked over 40 in a workweek. Construction workers who are paid less than prevailing wages for the work they perform or who do not receive time and one-half for overtime hours worked may be entitled to wage restitution (backwages). Also, maintenance workers employed at many public and Indian housing projects are covered by prevailing wage rates determined by HUD. Maintenance workers that do not receive prevailing wages or, in some cases, overtime pay, may also be entitled to wage restitution.

If you think that you may not have been paid correctly for construction or maintenance work that you performed on a HUD-assisted project, you can complete this questionnaire and submit it to HUD electronically by clicking on the “Submit” button at the end of the form. Or you can print your completed form and mail it to HUD at the following address:

U.S. Department of HUD

Office of Labor Relations

451 7^th Street, SW, Room 7116

Washington, DC 20410

We will review the information you provide and will let you know if you have been underpaid and, if so, we will work to ensure that you receive any additional wages that you may have earned. Please note that if we believe you have been underpaid, we will probably need to contact you for more information.

Please respond to all of the questions listed below. Your responses will be considered confidential and will not be released to anyone without your permission. Your answers should refer only to the time during which you worked on the HUD-assisted project.

If you have any questions, please contact a HUD Labor Relations Specialist. A list of contact names, addresses, telephone numbers, email addresses and the geographic areas they cover can be found at: http://portal.hud.gov/hudportal/HUD?src=/program_offices/labor_standards_enforcement/laborrelstf

If you have any questions, please call:      

Employer      

Project name, number and location                  

1. Your Name      

2. Your Job title      

3. When did you work on this project? From:       To:      

4. Where did you work (job site, shop, etc.)?      

5. What duties did you perform on this project?      

6. What tools (if any) did you use to perform your duties on the project?      

7. How was your wage determined? (hourly wage, salary, piece work, etc.)      

8. If your wage was based on piece work, describe how pay was determined (i.e., $ per board, per unit, etc.)?      

9a. What was your hourly wage rate on the project? $     

10a. Did you receive fringe benefits? Yes No

10b. If yes, which fringe benefits?

9b. If you know, what was the required prevailing wage for this project? $     

Vacation Medical Pension Other

Specify:      

11. On average, how many hours did you work each week?      

12. Did you ever work over 40 hours in a single week? Yes No

13. If you worked over 40 hours per week, did you receive overtime pay (1½ times your regular rate of pay)? Yes No

14. If you did not receive overtime pay for overtime hours worked, identify the number of weeks in which overtime was worked and/or total overtime hours      

15. Attach copies of check stubs or a record of your hours and pay received CHECK IF ATTACHED

16. Attach any other comments or statements on separate sheet CHECK IF ATTACHED

17. Identify other employees (name, address, phone) who worked with you and who could confirm the type of work you performed      

18. Identify employees (name, address, phone) you supervised      

How may we contact you?

Current address (Include apartment number, if any) (Street/City/State/Zip Code)                  

Home Phone Number (including area code)      

Permanent/Alternate Address (if current address is temporary)                  

Alternate Phone Number(s) (including area code)       Cell Phone      

Email address      

Date      

Disclosure Authorization

I authorize the HUD representative to disclose my name and the information I have submitted to the extent necessary to enforce my rights under the Acts administered by the U.S. Department of Housing and Urban Development.

Yes No

Signature:

Date:

SUBMIT PRINT

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. The information is considered sensitive and will not be released without your approval. Provision of this information is voluntary. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid Office of Management and Budget (OMB) control number.

HUD and local agencies administering HUD-assisted programs must enforce Federal wage and reporting requirements on covered HUD-assisted construction and maintenance work. Enforcement activities include contacting laborers and mechanics and requesting information about their employment on covered projects.

HUD-4730E (06/2004) PREVIOUS EDITION IS OBSOLETE