Form PW-6 "Prevailing Wage Complaint Form" - Missouri

What Is Form PW-6?

This is a legal form that was released by the Missouri Department of Labor and Industrial Relations - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2019;
  • The latest edition provided by the Missouri Department of Labor and Industrial Relations;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PW-6 by clicking the link below or browse more documents and templates provided by the Missouri Department of Labor and Industrial Relations.

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Download Form PW-6 "Prevailing Wage Complaint Form" - Missouri

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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
Send completed form to:
Division of Labor Standards
DIVISION OF LABOR STANDARDS
Attn: Prevailing Wage Program
PREVAILING WAGE COMPLAINT FORM
P.O. Box 449, Jefferson City, MO 65102-0449
For Workers on Public Works Projects
Phone: 573-751-3403
Fax: 573-751-3721
E-mail: prevailingwage@labor.mo.gov
Sections 290.210-290.340, RSMo
www.labor.mo.gov/DLS/PrevailingWage
Name
Date
Address
City
State
ZIP Code
Daytime Phone No.
Alternate Phone No.
E-mail Address
Are You:
Public Body
Project Contractor
Project Subcontractor
Project Worker
Type of Complaint
(Please check all appropriate boxes.)
Is total project cost over $75,000
Yes
No
Underpayment of wages
Incorrect occupational title of workers for type of work performed
Underpayment of fringe benefits (please identify fringes below)
Health and Welfare
Pension
Vacation
Holiday
No wage determination issued for project
Other: Explain:
PROJECT IDENTIFICATION – Complaint Against
Name of Contractor (Employer)
Address
Name of Business as Shown on Payroll Check
City
State
ZIP Code
County
Phone No.(s)
General (Prime) Contractor
Subcontractor
Yes
No
Are you currently employed by this contractor?
Yes
No
If not, have you ever been employed by this contractor?
Period employed on this project (month, day, year) From:
To:
Type of project:
Building
Heavy/Highway
Project Name
Project Location
City
County
Contracting Public Body (who is this job for)?
Pursuant to §290.290, RSMo, contractors and subcontractors that have engaged in the construction of public works are
required to keep their records for one year from the completion of the project.
Is project completed?
Yes
No
If Yes, when?
PW-6 (09-19) AI
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
Send completed form to:
Division of Labor Standards
DIVISION OF LABOR STANDARDS
Attn: Prevailing Wage Program
PREVAILING WAGE COMPLAINT FORM
P.O. Box 449, Jefferson City, MO 65102-0449
For Workers on Public Works Projects
Phone: 573-751-3403
Fax: 573-751-3721
E-mail: prevailingwage@labor.mo.gov
Sections 290.210-290.340, RSMo
www.labor.mo.gov/DLS/PrevailingWage
Name
Date
Address
City
State
ZIP Code
Daytime Phone No.
Alternate Phone No.
E-mail Address
Are You:
Public Body
Project Contractor
Project Subcontractor
Project Worker
Type of Complaint
(Please check all appropriate boxes.)
Is total project cost over $75,000
Yes
No
Underpayment of wages
Incorrect occupational title of workers for type of work performed
Underpayment of fringe benefits (please identify fringes below)
Health and Welfare
Pension
Vacation
Holiday
No wage determination issued for project
Other: Explain:
PROJECT IDENTIFICATION – Complaint Against
Name of Contractor (Employer)
Address
Name of Business as Shown on Payroll Check
City
State
ZIP Code
County
Phone No.(s)
General (Prime) Contractor
Subcontractor
Yes
No
Are you currently employed by this contractor?
Yes
No
If not, have you ever been employed by this contractor?
Period employed on this project (month, day, year) From:
To:
Type of project:
Building
Heavy/Highway
Project Name
Project Location
City
County
Contracting Public Body (who is this job for)?
Pursuant to §290.290, RSMo, contractors and subcontractors that have engaged in the construction of public works are
required to keep their records for one year from the completion of the project.
Is project completed?
Yes
No
If Yes, when?
PW-6 (09-19) AI
Supporting Documentation
(Please attach the following documents.)
Check stubs/copies of payroll checks
Photos/pictures of project/work performed
Other information (any supporting documentation)
SUMMARY OF COMPLAINT
(Use additional sheets, if necessary.)
STATEMENT OF VERIFICATION
I,
, do hereby affirm under penalties of perjury that the above-stated
information is true and correct to the best of my knowledge, information, and belief.
COMPLAINANT SIGNATURE
Supporting Documents: Please return this form to the Division of Labor Standards with any documentation in support of
the complaint. This includes, but is not limited to the following: name; check stubs; worksite photographs; copies of payroll
checks; payroll ledgers; dates when public works construction was performed; and so forth.
Missouri Department of Labor and Industrial Relations is an equal opportunity employer/program.
TDD/TTY: 800-735-2966 Relay Missouri: 711
PW-6-2 (09-19) AI
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