Standard Form 1444 - Request For Authorization Of Additional Classification And Rate
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1AUTHORIZED FOR LOCAL REPRODUCTION
CHECK APPROPRIATE BOX
REQUEST FOR AUTHORIZATION OF
OMB Number:
9000-0089
SERVICE CONTRACT
Expiration Date: 7/31/2014
ADDITIONAL CLASSIFICATION AND RATE
CONSTRUCTION CONTRACT
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the 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 FAR Secretariat (MVP), Office of Acquisition Policy, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork
Reduction Project (9000-0089), Washington, DC 20503.
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:
2. FROM: (REPORTING OFFICE)
ADMINISTRATOR, Employment Standards Administration
WAGE AND HOUR DIVISION
U.S. DEPARTMENT OF LABOR
WASHINGTON, D.C. 20210
3. CONTRACTOR
4. DATE OF REQUEST
9. DATE OPTION EXERCISED (If
6. DATE BID OPENED (SEALED
7. DATE OF AWARD
8. DATE CONTRACT WORK
5. CONTRACT NUMBER
APPLICABLE) (SCA ONLY)
BIDDING)
STARTED
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;
c. FRINGE BENEFITS
b. WAGE RATE(S)
AND RATIONALE FOR PROPOSED CLASSIFICATIONS (SCA ONLY)
PAYMENTS
(Use reverse or attach additional sheets, if necessary)
14. SIGNATURE AND TITLE OF SUBCONTRACTOR REPRESENTATIVE
15. SIGNATURE AND TITLE OF PRIME CONTRACTOR REPRESENTATIVE
(IF ANY)
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 (SCA) OR FAR 22.406-3 (DBA))
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 copies 1, 2, and 3 to Department of Labor)
SIGNATURE OF CONTRACTING OFFICER OR
TITLE AND COMMERCIAL TELEPHONE NO.
DATE SUBMITTED
REPRESENTATIVE
STANDARD FORM 1444
PREVIOUS EDITION IS USABLE
(REV. 12-2001)
Prescribed by GSA-FAR (48 CFR) 53.222(f)
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