{{ paytype === $parent.$parent.$parent.constants.responses.payType.hourly ? 'How many workers with disabilities were paid an hourly subminimum wage during the most recently completed fiscal quarter?' : 'How many workers with disabilities received subminimum wages and were paid piece rates during the most recently completed fiscal quarter?' }}

What was the job or contract on which the employer employed the largest number of workers {{ paytype === $parent.$parent.$parent.constants.responses.payType.hourly ? 'at hourly subminimum wage rates' : 'who received subminimum wages and were paid piece rates' }} during the most recently completed fiscal quarter?

Description of Work Performed

Which method did the employer use to determine the Prevailing Wage for the job or contract identified above?

Prevailing Wage Determined based on this survey

Source Employers

Source Employer Name

Address

Telephone Number

Full Name of Individual Contacted

Title of Individual Contacted

Date of Contact

Brief Description of Job/Task

Experienced Worker Wage Provided

Basis for Conclusion Wage Rate is Not Based on Entry Level

Description of Work (include job classification code, if known)

Alternate data source used

Prevailing wage provided by source

Date data retrieved

Attach the applicable SCA Wage Determination

Attach a work measurement or time study for ONE currently employed worker with a disability who is paid an hourly subminimum wage for the contract identified above.

Descripton of Work

Prevailing Wage Determined for This Job

Standard Productivity

Piece Rate Paid to Workers

Attach all documentation of the methods used to determine the standard productivity and the piece rate.