Form Wh-1 - Economic Survey Schedule - 1994 Page 2

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Payroll Period: From
Thru
of
Page
ECONOMIC SURVEY SCHEDULE
2
3
1
15. Name:
16. Address:
17. Wage order industry:
4
5
6
18. Wage order classification:
7
8
9
10
11
12
13
19. Wage order rate in effect during payroll period:
14
15
16
17
19
20. Number of covered employees under this
18
=
classification in this establishment: Total
0
0
0
EMPLOYMENT AND EARNINGS
21.
Salary or
Salary or
a.
b.
b.
a.
C.
C.
incentive earnings
incentive earnings
Straight
Straight
Number
Number
time
(1)
(2)
time
(1)
(2)
Total
Total
Of
Of
hourly
hourly
Hours
Hours
straight-
straight-
workers
workers
wage
wage
worked
worked
time
time
rate
rate
for
for
earnings
earnings
20 - 22
23 - 26
27 - 30
20 - 22
27 - 30
31 - 36
23 - 26
31 - 36
Public Burden Statement
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Completion of this
response is voluntary. We estimate that it will take an average of 45 minutes to complete this collection of information, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the U.S. Department of Labor, Administrator, Wage and Hour Division, ESA, Room S-3502, 200
Constitution Avenue, N.W., Washington, D.C. 2021 0 (Paperwork Reduction Project 1215-0028).
DO NOT SEND THE COMPLETED FORM TO EITHER OF THESE OFFICES

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