WD-10A (paper) Davis-Bacon Wage Survey Subcontractor Contact Informatio

OMB No. 1235-0015 Expiration xx/xx/xxxx

Davis-Bacon Wage Survey Subcontractor Contact Information (WD-10A) (Optional)
The purpose of this form is to collect contact information for potential survey respondents. We seek the information of your subcontractors in order to notify them of
the survey when it begins. Their participation is very important to us, as is yours.
Please identify by name the subcontractors that performed work on each project. Please also include each subcontractor’s address, phone number, and email address,
if available. If known, please identify the type of work performed by each subcontractor on reported projects. Use additional pages as necessary.
Name of firm submitting information:

The firm has construction workers to report on in the upcoming survey.
The firm does not have construction workers to report on in the upcoming survey.
Project Name

Subcontractor Name

Address

City

State

Zip
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Phone

Email address
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Type of Work Performed

–

Project Name

Subcontractor Name

Address

City

State

Zip

Phone

Email address
–

Type of Work Performed

–

Project Name

Subcontractor Name

Address

City

State

35023019

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Zip
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Phone

Email address
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FORM WD-10A (05-18-2023) D3

Type of Work Performed

Project Name

Subcontractor Name

Address

City

State

Zip
–

Phone

Email address
–

Type of Work Performed

–

Project Name

Subcontractor Name

Address

City

State

Zip
–

Phone

Email address
–

Type of Work Performed

–

Project Name

Subcontractor Name

Address

City

State

Zip
–

Phone

Email address
–

Note: This information is collected by the U.S. Department of Labor (DOL) as part of a wage survey under the authority of the Davis-Bacon and Related Acts (DBRA). The information will be
used by the DOL to identify contractors and subcontractors that performed construction work on projects in geographic areas where DOL will conduct surveys to determine prevailing wage
rates that will be the required minimum rates of pay for workers on construction projects covered by the DBRA. The submission of contractors and subcontractors’ information is strongly
encouraged but is voluntary. The use of this specific form to submit the requested contractors or subcontractors’ information is optional; respondents may use an alternate form if all the
required information is included. There is no penalty for not submitting the requested information. OMB No. XXXX-XXXX. Expires XX/XX/XXXX. Agencies may not conduct a collection of
information unless it displays a currently valid OMB control number. DOL estimates that the public reporting burden for this collection of information will average 10 minutes per response,
including time for reviewing instructions, gathering the requested information, and completing and reviewing the collection of information. Send comments regarding the burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden, to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502,
200 Constitution Avenue, N.W., Washington, DC 20210 and reference the OMB Control Number.

FORM WD-10A (05-18-2023) D3

35023027

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Type of Work Performed