Form WHD-943B "Prevailing Wage Complaint" - Michigan

What Is Form WHD-943B?

This is a legal form that was released by the Michigan Department of Licensing and Regulatory Affairs - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the Michigan Department of Licensing and Regulatory Affairs;
  • 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 printable version of Form WHD-943B by clicking the link below or browse more documents and templates provided by the Michigan Department of Licensing and Regulatory Affairs.

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Download Form WHD-943B "Prevailing Wage Complaint" - Michigan

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BEFORE FILING A WAGE CLAIM,
PLEASE READ THESE INSTRUCTIONS CAREFULLY!
Do Not Fill Out The Prevailing Wage Complaint Form If:
You acted as an "independent contractor" and not as an "employee" of the business.
You are self-employed or an owner/operator.
You have filed suit against your employer for the same wage or fringe benefit claim.
You already have a civil court judgment involving this claim.
You are trying to obtain a W-2 or 1099. If so, you should contact the Internal Revenue
Service
at 1-800-829-1040.
Your employer has filed bankruptcy or has been determined bankrupt. If so, you will need to
contact the Bankruptcy Court for further instructions.
You do not know your employer’s address or location.
The statute of limitations for your claim has expired. A 3-year statute of limitations applies
when filing a complaint for prevailing wages.
FILING A WAGE CLAIM
IF THE CLAIM FORM IS NOT COMPLETED AS INDICATED IN THESE INSTRUCTIONS IT
MAY BE RETURNED TO YOU.
If you intend to file against more than one business use a separate wage claim form for each
business against whom you wish to file a claim. Also, each claimant intending to file against an
employer must use a separate claim form.
Read all questions on the claim form carefully before answering.
Fill out the claim form
completely, legibly and accurately, providing as much of the requested information as possible.
In order for your claim to be processed the following information must be provided:
Name and address of the complainant.
Provide a telephone number where you may be reached during the day. If your address
or telephone number changes, it is your responsibility to notify the Division
immediately or your claim may be closed.
Name and address of contractor alleged to have committed the violation. Your claim will be
returned if a complete address is not provided.
Contracting agent name and address, project name and description, location where the
work was performed; and construction dates.
WHD-943B
BEFORE FILING A WAGE CLAIM,
PLEASE READ THESE INSTRUCTIONS CAREFULLY!
Do Not Fill Out The Prevailing Wage Complaint Form If:
You acted as an "independent contractor" and not as an "employee" of the business.
You are self-employed or an owner/operator.
You have filed suit against your employer for the same wage or fringe benefit claim.
You already have a civil court judgment involving this claim.
You are trying to obtain a W-2 or 1099. If so, you should contact the Internal Revenue
Service
at 1-800-829-1040.
Your employer has filed bankruptcy or has been determined bankrupt. If so, you will need to
contact the Bankruptcy Court for further instructions.
You do not know your employer’s address or location.
The statute of limitations for your claim has expired. A 3-year statute of limitations applies
when filing a complaint for prevailing wages.
FILING A WAGE CLAIM
IF THE CLAIM FORM IS NOT COMPLETED AS INDICATED IN THESE INSTRUCTIONS IT
MAY BE RETURNED TO YOU.
If you intend to file against more than one business use a separate wage claim form for each
business against whom you wish to file a claim. Also, each claimant intending to file against an
employer must use a separate claim form.
Read all questions on the claim form carefully before answering.
Fill out the claim form
completely, legibly and accurately, providing as much of the requested information as possible.
In order for your claim to be processed the following information must be provided:
Name and address of the complainant.
Provide a telephone number where you may be reached during the day. If your address
or telephone number changes, it is your responsibility to notify the Division
immediately or your claim may be closed.
Name and address of contractor alleged to have committed the violation. Your claim will be
returned if a complete address is not provided.
Contracting agent name and address, project name and description, location where the
work was performed; and construction dates.
WHD-943B
Description of the complaint.
Identify classification of each construction mechanic alleged to be underpaid.
Attach copies of any documents that you have, which support your claim such as an
employment contract, time records, check stubs, fringe benefit policies, etc.
A wage claim may be filed in person from 8 a.m. to 5 p.m., Monday through Friday, at 530 W.
Allegan St., Lansing, MI 48933 or by mailing to:
Department of Licensing and Regulatory Affairs
Wage and Hour Division
PO Box 30476
Lansing, Michigan 48909-7976
When the Wage and Hour Division receives your claim form the following steps are
taken:
1.
The claim form is given to an investigator to review. The investigator determines if all of
the required information is on the claim form and whether investigation of the claim is within
the Division’s authority.
2.
The claim is then opened and a notification letter sent by the Division to the employer
requesting a written response within 14 working days. The letter requests documentation
regarding the claim that has been filed and/or a check for any portion of the claim not
disputed. Any monies received will be forwarded to you. You do not need to contact the
Wage and Hour Division to receive payment.
3.
All investigators work on a first-in, first-out basis. This means that you will not be contacted
by the investigator assigned to your claim until the claim comes up in rotation on his/her
caseload. This may take a while. The time required to complete an investigation depends
on the cooperation of the parties involved, and the complexity of the claim. In the interim,
you should obtain whatever records or documentation you have to support your claim and
have it available when the investigator contacts you.
4.
It is important that you notify the Wage and Hour Division of any change in your address or
daytime phone number. Failure to report this information will delay the investigation of your
complaint. In addition, the Division cannot mail any monies received without a current
address.
By filing this claim with the Wage and Hour Division, you are electing a remedy which
may prevent you from pursuing this claim elsewhere, including civil court.
WHD-943B
Claim Number:
PREVAILING WAGE COMPLAINT
LARA is an equal opportunity employer/program. Auxiliary aids,
Michigan Department Licensing and Regulatory Affairs
services and other reasonable accommodations are available, upon
Wage and Hour Division
request, to individuals with disabilities. Please call 1-855-464-9243
to make your needs known to this agency.
Mailing Address:
Street Address:
AUTHORITY:
PUBLIC ACT 166 OF 1965, AS AMENDED
COMPLETION:
P.O. Box 30476
530 W. Allegan St.
VOLUNTARY
Lansing, MI 48909-7976
Lansing, MI 48933
PENALTY:
NONE
Toll Free: 1-855-464-9243
Facsimile: 517-322-6352
Attach with complaint sufficient evidence to support your allegation
(i.e., payroll records, project's prevailing wage rates, pay stubs, etc.)
Website: www.michigan.gov/wagehour
COMPLAINANT INFORMATION Complete only one section: A or B. A=Individual B=Third Party
A. EMPLOYEE NAME:
B. NAME:
(if filing as an individual)
(if filing as a third party)
LAST FOUR DIGITS OF SOCIAL SECURITY #:
ORGANIZATION YOU REPRESENT:
(if filing as
(if filing as a third party)
an individual)
DATE OF BIRTH:
(if filing as an individual)
ADDRESS
(if you completed Section A, use individual's address; if you completed Section B, use organization's address)
CITY, STATE, ZIP:
COUNTY:
TELEPHONE NUMBER WHERE YOU CAN BE CONTACTED BETWEEN 8:00
A.M. AND 5:00 P.M., MONDAY THRU FRIDAY:
EMPLOYER INFORMATION
CONTRACTOR/SUBCONTRACTOR NAME:
ADDRESS:
CITY, STATE, ZIP:
COUNTY:
TELEPHONE NUMBER:
PROJECT INFORMATION
CONTRACTING AGENT
:
(i.e., school, state agency, university, etc.)
CONTRACTING AGENT ADDRESS:
CITY, STATE, ZIP:
TELEPHONE NUMBER:
PROJECT NAME:
PROJECT DESCRIPTION:
PROJECT LOCATION
:
(STREET ADDRESS, CITY, COUNTY, STATE and ZIP)
DATES WORKED ON THE PROJECT:
EMPLOYEE JOB CLASSIFICATION(S)
(i.e.,: carpenter, plumber, electrician, etc.)
IS EMPLOYEE AN APPRENTICE?
Yes
No
IF YES, APPROXIMATELY HOW MANY APPRENTICES ON SITE?
WHD-943B (2/17)
PLEASE COMPLETE THE REVERSE SIDE OF THIS FORM
Page 1
PREVAILING WAGE COMPLAINT
ALLEGATION OF COMPLAINT
ATTACH WITH COMPLAINT SUFFICIENT EVIDENCE TO SUPPORT YOUR ALLEGATION (I.E., PAYROLL RECORDS,
PROJECT'S PREVAILING WAGE RATES, PAY STUBS, ETC.)
DESCRIBE THE COMPLAINT – Include in detail the tasks performed on this project and identify the working title of the
job classification.
How did you determine the contractor was in violation of the prevailing wage law?
What was the specific job title of the employee(s)?
Please describe in detail the specific job duties the employee(s) was required to perform.
Did the employee(s) supervise others?
Yes
No
Who is the direct supervisor of the employee(s)?
What was the hourly rate of pay for the employee(s)?
Start date of employment:
End date of employment:
Check any fringe benefits the employer provided:
health and welfare contributions
vacation pay
pension or retirement contributions
medical insurance
profit sharing distribution
life insurance
annuity fund or tax deferred savings plan contributions
holiday pay
supplemental employment fund contributions
bonus
education or training fund contributions
scholarship contributions
Any additional information you wish to add:
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