Form Wh-226 - Application For Authority To Employ Workers With Disabilities At Special Minimum Wages - 2008 Page 3

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12. TEMPORARY AUTHORITY: To be completed only by a vocational rehabilitation program administered by a State agency or the U.S. Veterans

Administration.

Check if this is a request for temporary authority to employ workers with disabilities at special minimum wages pursuant to a vocational rehabilitation

program of the Veterans Administration for veterans with a service-incurred disability or a vocational rehabilitation program administered by a State

agency. A copy of the signed application will constitute the temporary authority provided the application is mailed to the Department of Labor at

the address listed at the top of page 1 of this form within ten days of the signing. Temporary authority will exist for 90 days from the date the application

is signed and cannot be extended or renewed by the issuing agency. (See 29 C.F.R. § 525.8 and instructions on page 4 of this

application.)

13. REPRESENTATIONS AND WRITTEN ASSURANCES

I certify that I have read this form and to the best of my knowledge and belief, all answers and information given in the application and attachments are

true; that the representations set forth in support of this application to obtain or continue the authorization to pay workers with disabilities at subminimum

wage rates are true; and I acknowledge that the authorization, if issued or continued, is subject to revocation in accordance with the provisions of 29

C.F.R. part 525.

I represent that as set forth in the regulations governing the employment of workers with disabilities, the following conditions exist and will continue to exist:

1) Workers employed under the authority in 29 C.F.R. part 525 have disabilities for the work to be performed;

2) Wage rates paid to workers with disabilities under the authority in 29 C.F.R. part 525 are commensurate with those paid experienced

workers, who do not have disabilities, in industry in the vicinity for essentially the same type, quality, and quantity of work;

3) The operations are and will continue to be in compliance with the FLSA, PCA, SCA, and Contract Work Hours and Safety Standards Act (CWHSSA),

an overtime statute for federal contract work, as applicable;

4) No deductions will be made from the commensurate wages earned by a patient worker to cover the cost of room, board or other services provided

by the facility;

5) Records required under 29 C.F.R. part 525 with respect to documentation of disability, productivity, time studies or work measurements, and

prevailing wage surveys will be maintained.

Further, I certify that:

1) The wage rates of all hourly-rated employees paid in accordance with FLSA section 14(c) will be reviewed at least every six months;

and

2) Wages paid to all employees under FLSA section 14(c) will be adjusted at periodic intervals, at least once a year, to reflect changes in the prevailing

wage paid to experienced workers, who do not have disabilities, employed in the vicinity for essentially the same type of work.

14. SIGNATURE OF AUTHORIZED REPRESENTATIVE

Name (Print or Type)

Title

Signature

Date

Public Burden Statement

The Department of Labor estimates it will take an average of 45 minutes for respondents to complete this collection of information, including the

time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the

collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including

suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200

Constitution Avenue, N.W., Washington, DC 20210. DO NOT SEND THE COMPLETED FORM TO THIS OFFICE.