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OMB Control Number: 9000-0066
Service Contract
Expiration Date: 5/31/2025
Construction Contract
Instructions: The Contractor shall complete items 3 through 16, keep a pending copy, and submit
the request, in quadruplicate, to the Contracting Officer.
Request For Authorization Of
Additional Classification And Rate
1. To:
Administrator,
Wage And Hour Division
U.S. Department Of Labor
Washington, DC 20210
3. Contractor
2. From: (Reporting Office)
4. Date Of Request
7. Date Of
5. Contract Number 6. Date Bid
Award
Opened (Sealed
Bidding)
8. Date Contract 9. Date Option Exercised
(If Applicable) (Service
Work Started
Contract Only)
10. Subcontractor (If Any)
11. Project And Description Of Work (Attach Additional Sheet If Needed)
12. Location (City, County, And State)
13. In Order To Complete The Work Provided For Under The Above Contract, It Is Necessary To
Establish The Following Rate(s) For The Indicated Classification(s) Not Included In The Department
Of Labor Determination
Number:
Dated:
b. Wage Rate(s)
c. Fringe Benefits
a. List In Order: Proposed Classification Title(s); Job
Payments
Description(s); Duties; And Rationale For Proposed
Classifications (Service contracts only)
(Use reverse or attach additional sheets, if necessary)
14. Signature And Title Of Subcontractor
Representative (If Any)
Authorized For Local Reproduction
Previous Edition Is Not Usable
15. Signature And Title Of Prime Contractor
Representative
STANDARD FORM 1444 (REV. 10/2023)
Prescribed by GSA-FAR (48 CFR) 53.222(f)
16. Signature Of Employee Or Representative
Check Appropriate Box Referencing Block 13.
Agree
Disagree
Title
To Be Completed By Contracting Officer (Check As Appropriate - See FAR 22.1019 (Service
Contract Labor Standards) Or FAR 22.406-3 (Construction Wage Rate Requirements))
The Interested Parties Agree And The Contracting Officer Recommends Approval By The Wage
And Hour Division. Available Information And Recommendations Are Attached.
The Interested Parties Cannot Agree On The Proposed Classification And Wage Rate. A
Determination Of The Question By The Wage And Hour Division Is Therefore Requested. Available
Information And Recommendations Are Attached.
(Send 3 copies to the Department of Labor)
Signature Of Contracting Officer Or
Representative
Title And Commercial
Telephone Number
Date Submitted
Paperwork Reduction Act Statement
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a
valid Office of Management and Budget (OMB) control number. The OMB control number for this
collection is 9000-0066. We estimate that it will take .5 hours to read the instructions, gather the facts,
and answer the questions. Send only comments relating to our time estimate, including suggestions for
reducing this burden, or any other aspects of this collection of information to: U.S. General Services
Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.
STANDARD FORM 1444 (REV. 10/2023) BACK
File Type | application/pdf |
File Title | Standard Form 1444 - Request for Authorization of Additional Classification and Rate |
File Modified | 2023-10-13 |
File Created | 2023-10-13 |