Employee Data Certification. 5. Section 3 Posted Notice to Project Residents CERTIFIED PAYROLL FORM NOTICE: For Xxxxx Xxxxx Act-Applicable Projects Only A fillable form is available at the following link: xxxxx://xxx.xxx.xxx/whd/forms/wh347.pdf PAYROLL DEDUCTION AUTHORIZATION FORM “OTHER DEDUCTIONS” ON CERTIFIED PAYROLL NOTICE: For Xxxxx Bacon Act-Applicable Projects Only Contractors place this form on Company Letterhead Project Name: Employee’s Name: I, , hereby authorize _to (Employee Name) (Nameof Employer/Company) deduct $ from my paycheck. This deduction is for: Loan Repayment Retirement Profit Sharing Advance Charitable Donations Savings Bonds Insurance Premiums Other: This deduction is to be made: One time only Weekly Monthly times over weeks Other: Employee’s Signature: Date: You may make payroll deductions as permitted by DOL regulations 29 CFR Part 3. These regulations prohibit the employer from requiring employees to “kick-back” (i.e. give up or return to the employer) any of their earnings other than those identified. You need to submit this documentation only one time per employee, unless changes in deductions or durations take place. *If deductions are being made for child support, a copy of the court ordered withholding must be included.
