{{ 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?' }}

Provide the total number of workers paid {{ paytype === 'hourly' ? 'an ' : 'on a '}} {{ paytype === 'hourly' ? 'hourly' : 'piece rate'}} {{ paytype === 'hourly' ? ' subminimum wage rate' : ' basis that resulted in a subminimum wage'}} at any time during the most recently completed fiscal quarter. {{ validate(modelPrefix() + '.numWorkers') }}

Identify the job or contract and provide a brief description of the work performed by workers paid subminimum wages {{ paytype === 'hourly' ? '(e.g., Name: Kitchen cleaning, Description: sink, counters, stove, refrigerator, microwave cleaning duties, or Name: Contract No. 123-456 with Sheets Inc., Description: Laundry Service).' : '(e.g., Gadget disassembly, or Contract No. 000-111 with Widgets Inc.—Hand Assembly of Boxes (28” x 12”)).'}} {{ validate(modelPrefix() + '.jobName') }} Name of Job or Contract

{{ validate(modelPrefix() + '.jobDescription') }} Description of Work Performed on this Job/Contract by Workers Paid Subminimum Wages

For information on prevailing wages, see Fact Sheet #39B: Prevailing Wages and Commensurate Wages under Section 14(c) of the FLSA. {{ validate(modelPrefix() + '.prevailingWageMethod') }}

{{ response.display }}

Provide information for the most recent prevailing wage survey conducted for the job or contract identified above:

Prevailing wage determined based on this survey

The prevailing wage rate determined from the surveys may be calculated by using a weighted or straight average, but the same method should be used to calculate all of the employer’s prevailing wage rates. {{ validate(modelPrefix() + '.mostRecentPrevailingWageSurvey.prevailingWageDetermined') }}

You must provide at least 3 Source Employers for the survey

If the employer used more than three sources, provide the information obtained from all sources. The source employers surveyed should be located in the geographic area from which the labor force of the applicant is drawn. The sources for the jobs surveyed should use similar methods and equipment as the job for which this rate will apply.

Add a Source Employer

Source Employer Name {{ vm.validateActiveSourceEmployerProperty('employerName') }}

Street address {{ vm.validateActiveSourceEmployerProperty('address.streetAddress') }}

City {{ vm.validateActiveSourceEmployerProperty('address.city') }}

State {{ vm.validateActiveSourceEmployerProperty('address.state') }}

ZIP {{ vm.validateActiveSourceEmployerProperty('address.zipCode') }}

Telephone Number {{ vm.validateActiveSourceEmployerProperty('phone') }}

First Name of Individual Contacted {{ vm.validateActiveSourceEmployerProperty('contactFirstName') }}

Last Name of Individual Contacted {{ vm.validateActiveSourceEmployerProperty('contactLastName') }}

Title Name of Individual Contacted {{ vm.validateActiveSourceEmployerProperty('contactTitle') }}

Date of Contact {{ vm.validateActiveSourceEmployerProperty('contactDate') }}

Brief Description of Job/Task

For example, “Hand assembly of cardboard shipping boxes.” {{ vm.validateActiveSourceEmployerProperty('jobDescription') }}

Experienced Worker Wage Provided

The wage rate collected from each source should be the hourly rate paid to experienced (not entry level) workers who do not have disabilities that affect productive capacity. An experienced worker is a worker who has learned the basic requirements of the work to be performed, ordinarily by completion of a probationary or training period. Typically, an experienced worker will have received at least one pay raise after successful completion of the probationary or training period. {{ vm.validateActiveSourceEmployerProperty('experiencedWorkerWageProvided') }}

Basis for Conclusion Wage Rate is Not Based on Entry Level

For example, “Entry rate = $10,” “Entry rate = $9.50; raise given after probationary period,” or “Contact confirmed rate was for experienced workers.” {{ vm.validateActiveSourceEmployerProperty('conclusionWageRateNotBasedOnEntry') }}

List of Source Employers
Source Employer Name	Experienced Wage Provided	Options
Please review this employer {{ employer.employerName }}	${{ employer.experiencedWorkerWageProvided }}

If conducting surveys is not practical, the employer may instead use U.S. Bureau of Labor Statistics (BLS) or private or State employment services data. BLS wage data can be found at www.bls.gov/bls/blswage.htm (e.g., BLS Occupational Employment Survey; BLS Current Population Survey). Data from employment services may only be used to determine prevailing wages if the data provides wage rates of experienced workers not disabled for the work being performed; entry level wage data may not be used.

Description of work (include job classification code, if known) {{ validate(modelPrefix() + '.alternateWageData.alternateWorkDescription') }}

Alternate data source used {{ validate(modelPrefix() + '.alternateWageData.alternateDataSourceUsed') }}

Prevailing wage provided by source {{ validate(modelPrefix() + '.alternateWageData.prevailingWageProvidedBySource') }}

Date data retrieved {{ validate(modelPrefix() + '.alternateWageData.dataRetrieved') }}

Attach the applicable SCA Wage Determination {{ validate(modelPrefix() + '.scaWageDeterminationAttachmentId') }}

How frequently does the employer conduct work measurements or time studies of each worker with a disability who is paid an hourly subminimum wage? {{ validate(modelPrefix() + '.workMeasurementFrequency') }}

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.

The time study provided must be the most recent time study conducted for that worker. The hourly rate time study provided should include the productivity rating and evaluation forms used to determine the employee’s commensurate wage rate. The documentation should include all materials related to the work measurement, such as:

detailed task analysis (including quality and quantity measures),
wage and productivity of an experienced worker who is not disabled for the work performing the same job(i.e., "standard setter"), and
determination of the worker’s individual productivity.

Provide a current piece rate work measurement or time study for the job/contract reflected in the prevailing wage survey above.

Descripton of work (e.g. packaging, shrink-wrapping, labeling) {{ validate(modelPrefix() + '.pieceRateWorkDescription') }}

Prevailing Wage Determined for This Job {{ validate(modelPrefix() + '.prevailingWageDeterminedForJob') }} rate per hour

Standard Productivity {{ validate(modelPrefix() + '.standardProductivity') }} units per hour

Piece Rate Paid to Workers {{ validate(modelPrefix() + '.pieceRatePaidToWorkers') }} rate per unit

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

For example:

detailed task analysis (including quality and quantity measures), and
productivity of an experienced worker who is not disabled for the work performing the same job (i.e., “standard setter”).