Form HUD 4230A HUD 4230A REPORT OF ADDITIONAL CLASSIFICATION AND RATE

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT REPORT OF ADDITIONAL CLASSIFICATION AND RATE

HUD FORM 4230A

OMB Approval Number 2501-0011 (Exp. xx/xx/xxxx)

1. FROM (name and address of requesting agency)      

2. PROJECT NAME AND NUMBER            

3. LOCATION OF PROJECT (City, County and State)      

4. BRIEF DESCRIPTION OF PROJECT      

5. CHARACTER OF CONSTRUCTION

Building Heavy Highway

Residential Other (specify)      

6. WAGE DECISION NO. (include modification number, if any)       COPY ATTACHED

DATE of WAGE DECISION      

7. WAGE DECISION EFFECTIVE DATE or LOCK-IN?      

8.

WORK CLASSIFICATION(S)

HOURLY WAGE RATES

BASIC WAGE

FRINGE BENEFIT(S) (if any)

                                                                 

                                                                 

                                                                 

9. PRIME CONTRACTOR (name, address)            

9c. Agree Disagree

10. SUBCONTRACTOR/EMPLOYER, IF APPLICABLE (name, address)                        

9a. SIGNATURE      

DATE

Check All That Apply:

The work to be performed by the additional classification(s) is not performed by a classification in the applicable wage decision.

The proposed classification is utilized in the area by the construction industry.

The proposed wage rate(s), including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage decision.

The interested parties, including the employees or their authorized representatives, agree on the classification(s) and wage rate(s).

Supporting documentation attached, including applicable wage decision.

Check One:

Approved, meets all criteria. DOL confirmation requested.

One or more classifications fail to meet all criteria as explained in agency referral. DOL decision requested.

     

     

FOR HUD USE ONLY LR2000: 

Agency Representative (Typed name and signature)

Date

Log in:      

     

Log out:      

Phone Number

HUD-4230A (2-19) PREVIOUS EDITION IS OBSOLETE