Enclosure 4 - Attachment 6 - SF-1444.pdf
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Department of Energy Office of Science
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REQUEST FOR AUTHORIZATION OF
ADDITIONAL CLASSIFICATION AND RATE
INSTRUCTIONS: THE CONTRACTOR SHALL COMPLETE ITEMS 3 THROUGH 16, KEEP A PENDING COPY, AND SUBMIT THE REQUEST, IN
QUADRUPLICATE, TO THE CONTRACTING OFFICER.
1. TO:
ADMINISTRATOR,
WAGE AND HOUR DIVISION
U.S. DEPARTMENT OF LABOR
WASHINGTON, DC 20210
2. FROM: (REPORTING OFFICE)
3. CONTRACTOR 4. DATE OF REQUEST
5. CONTRACT NUMBER 6. DATE BID OPENED (SEALED
BIDDING)
7. DATE OF AWARD 8. DATE CONTRACT WORK
STARTED
9. DATE OPTION EXERCISED (If
APPLICABLE) (SERVICE
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:
a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES;
AND RATIONALE FOR PROPOSED CLASSIFICATIONS (Service contracts only) b. WAGE RATE(S)
c. FRINGE BENEFITS
PAYMENTS
(Use reverse or attach additional sheets, if necessary)
14. SIGNATURE AND TITLE OF SUBCONTRACTOR REPRESENTATIVE
(IF ANY)
15. SIGNATURE AND TITLE OF PRIME CONTRACTOR REPRESENTATIVE
16. SIGNATURE OF EMPLOYEE OR REPRESENTATIVE TITLE CHECK APPROPRIATE BOX-REFERENCING BLOCK 13.
AGREE DISAGREE
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
STANDARD FORM 1444 (REV. 4/2013)
Prescribed by GSA-FAR (48 CFR) 53.222(f)
TITLE AND COMMERCIAL TELEPHONE NUMBER DATE SUBMITTED
CHECK APPROPRIATE BOX
SERVICE CONTRACT
CONSTRUCTION CONTRACT
PREVIOUS EDITION IS USABLE
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.
OMB Control Number: 9000-0066 Expiration Date: 5/31/2025
AUTHORIZED FOR LOCAL REPRODUCTION
REQUEST FOR AUTHORIZATION OF
ADDITIONAL CLASSIFICATION AND RATE
INSTRUCTIONS: THE CONTRACTOR SHALL COMPLETE ITEMS 3 THROUGH 16, KEEP A PENDING COPY, AND SUBMIT THE REQUEST, IN
QUADRUPLICATE, TO THE CONTRACTING OFFICER.
1. TO:
ADMINISTRATOR,
WAGE AND HOUR DIVISION
U.S. DEPARTMENT OF LABOR
WASHINGTON, DC 20210
2. FROM: (REPORTING OFFICE)
3. CONTRACTOR
4. DATE OF REQUEST
5. CONTRACT NUMBER
6. DATE BID OPENED (SEALED
BIDDING)
7. DATE OF AWARD
8. DATE CONTRACT WORK
STARTED
9. DATE OPTION EXERCISED (If
APPLICABLE) (SERVICE 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:
a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES;
AND RATIONALE FOR PROPOSED CLASSIFICATIONS (Service contracts only)
b. WAGE RATE(S)
c. FRINGE BENEFITS
PAYMENTS
(Use reverse or attach additional sheets, if necessary)
14. SIGNATURE AND TITLE OF SUBCONTRACTOR REPRESENTATIVE
(IF ANY)
15. SIGNATURE AND TITLE OF PRIME CONTRACTOR REPRESENTATIVE
16. SIGNATURE OF EMPLOYEE OR REPRESENTATIVE
TITLE
CHECK APPROPRIATE BOX-REFERENCING BLOCK 13.
AGREE
DISAGREE
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
STANDARD FORM 1444 (REV. 4/2013)
Prescribed by GSA-FAR (48 CFR) 53.222(f)
TITLE AND COMMERCIAL TELEPHONE NUMBER
DATE SUBMITTED
CHECK APPROPRIATE BOX
SERVICE CONTRACT
CONSTRUCTION CONTRACT
PREVIOUS EDITION IS USABLE
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.
OMB Control Number: 9000-0066 Expiration Date: 5/31/2025
AUTHORIZED FOR LOCAL REPRODUCTION
8.2.1.4029.1.523496.503679 Standard Form 1444 - Request for Authorization of Additional Classification and Rate
| CHECK APPROPRIATE BOX. SERVICE CONTRACT: 0 |
| CHECK APPROPRIATE BOX. CONSTRUCTION CONTRACT: 1 |
| 2. FROM: (REPORTING OFFICE): |
| 3. CONTRACTOR: |
| 4. DATE OF REQUEST. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 9. DATE OPTION EXERCISED (If APPLICABLE) (SCA ONLY) Enter 2 digit month, 2 digit day and 4 digit year.: |
| 8. DATE CONTRACT WORK STARTED. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 7. DATE OF AWARD. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 6. DATE BID OPENED (SEALED BIDDING) Enter 2 digit month, 2 digit day and 4 digit year.: |
| 5. CONTRACT NUMBER: |
| 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: |
| 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. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 1 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 9 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 10 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 8 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 7 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 6 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 5 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 4 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 3 of 10.: |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 13b. WAGE RATE(S): |
| 13a. LIST IN ORDER: PROPOSED CLASSIFICATION TITLE(S); JOB DESCRIPTION(S); DUTIES; AND RATIONALE FOR PROPOSED CLASSIFICATIONS 2 of 10.: |
| 13b. WAGE RATE(S): |
| 13c. FRINGE BENEFITS PAYMENTS: |
| 14. TITLE OF SUBCONTRACTOR REPRESENTATIVE (IF ANY): |
| TITLE: |
| CHECK APPROPRIATE BOX-REFERENCING BLOCK 13. AGREE: 0 |
| CHECK APPROPRIATE BOX-REFERENCING BLOCK 13. DISAGREE: 0 |
| THE INTERESTED PARTIES AGREE AND THE CONTRACTING OFFICER RECOMMENDS APPROVAL BY THE WAGE AND HOUR DIVISION. AVAILABLE INFORMATION AND RECOMMENDATIONS ARE ATTACHED.: 0 |
| 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.: 0 |
| TITLE : |
| COMMERCIAL TELEPHONE NUMBER: |
| DATE SUBMITTED. Enter 2 digit month, 2 digit day and 4 digit year.: |
| 15. SIGNATURE OF PRIME CONTRACTOR REPRESENTATIVE: |
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