U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT REPORT OF ADDITIONAL CLASSIFICATION AND RATE |
HUD FORM 4230A |
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OMB Approval Number 2501-0011 (Exp. xx/xx/xxxx) |
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1. FROM (name and address of requesting agency)
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2. PROJECT NAME AND NUMBER
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3. LOCATION OF PROJECT (City, County and State)
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4. BRIEF DESCRIPTION OF PROJECT
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5. CHARACTER OF CONSTRUCTION |
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Building Heavy Highway |
Residential Other (specify)
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6. WAGE DECISION NO. (include modification number, if any)
COPY ATTACHED |
DATE of WAGE DECISION
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7. WAGE DECISION EFFECTIVE DATE or LOCK-IN?
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8. |
WORK CLASSIFICATION(S) |
HOURLY WAGE RATES |
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BASIC WAGE |
FRINGE BENEFIT(S) (if any) |
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9. PRIME CONTRACTOR (name, address)
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9c.
Agree
Disagree |
10. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE (name, address)
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9a. SIGNATURE
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DATE
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Check All That Apply: |
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The work to be performed by the additional classification(s) is not performed by a classification in the applicable wage decision. |
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The proposed classification is utilized in the area by the construction industry. |
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The proposed wage rate(s), including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage decision. |
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The interested parties, including the employees or their authorized representatives, agree on the classification(s) and wage rate(s). |
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Supporting documentation attached, including applicable wage decision. |
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Check One: |
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Approved, meets all criteria. DOL confirmation requested. |
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One or more classifications fail to meet all criteria as explained in agency referral. DOL decision requested. |
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FOR HUD USE ONLY LR2000:
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Agency Representative (Typed name and signature) |
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Date |
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Log in: |
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Log out: |
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Phone Number |
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HUD-4230A (2-19) PREVIOUS EDITION IS OBSOLETE |
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File Type | application/msword |
Author | Steven A. Bales |
Last Modified By | SYSTEM |
File Modified | 2019-04-03 |
File Created | 2019-04-03 |