Pa Form Payroll PDF Details

Pa Form payroll is a Pennsylvania state form that employers must use to report employee wages and withholding. The form is also used to report unemployment compensation and workers' compensation premiums. employers must file the form electronically with the Department of Labor and Industry every quarter. The department will then use the information to ensure that employers are complying with state laws.

You'll discover info about the type of form you wish to complete in the table. It can tell you the amount of time you'll need to complete pa form payroll, what fields you will need to fill in, and so forth.

QuestionAnswer
Form NamePa Form Payroll
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespennsylvania weekly certification, pennsylvania form payroll, pa prevailing wage form, llc 25 fillable

Form Preview Example

WEEKLY PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS

Contractor or

Subcontractor (Please check one) ALL INFORMATION MUST BE COMPLETED

CONTRACTOR

SUBCONTRACTOR

ADDRESS

ADDRESS

PAYROLL NUMBER WEEK ENDING DATE

PROJECT AND LOCATION

 

BUREAU OF LABOR LAW COMPLIANCE

 

PREVAILING WAGE DIVISION

 

 

 

 

 

 

7TH & FORSTER STREETS

 

PROJECT SERIAL #

PROJECT #

HARRISBURG, PA 17120

 

1-800-932-0665

EMPLOYEE NAME

APPR. WORK

RATE CLASSIFICATION

(%)

DAY AND DATE

HOURS WORKED EACH DAY

S-

TIME

0-

TIME

BASE

TOTAL FRINGE

BENEFITS

HOURLY

(C=Cash)

RATE

(FB=Contributions)*

 

TOTAL

DEDUCTIONS

GROSS PAY

FOR

PREVAILING RATE JOB(S)

CHECK #

C:

FB:

C:

FB:

C:

FB:

C:

FB:

C:

FB:

* SEE REVERSE SIDE

PAGE NUMBER ___________ OF ____________

LLC-25 REV 10 -03 (Page 1)

THE NOTARIZATION MUST BE COMPLETED ON FIRST AND LAST SUBMISSIONS ONLY. ALL OTHER INFORMATION MUST BE COMPLETED WEEKLY.

*FRINGE BENEFITS EXPLANATION (FB): Bona fide benefits contribution, except those required by Federal or State Law (unemployment tax, workers’ compensation, income taxes, etc.)

Please specify the type of benefits provided and contributions per hour:

1)Medical or hospital care__________________________________________________________________________

2)Pension or retirement ____________________________________________________________________________

3)Life insurance _________________________________________________________________________________

4)Disability _____________________________________________________________________________________

5)Vacation, holiday _______________________________________________________________________________

6)Other (please specify) ___________________________________________________________________________

CERTIFIED STATEMENT OF COMPLIANCE

1.The undersigned, having executed a contract with _____________________________________________________

(AWARDING AGENCY, CONTRACTOR OR SUBCONTRACTOR)

______________________________ for the construction of the above-identified project, acknowledges that:

(a)The prevailing wage requirements and the predetermined rates are included in the aforesaid contract.

(b)Correction of any infractions of the aforesaid conditions is the contractor’s or subcontractor’s responsibility.

(c)It is the contractor’s responsibility to include the Prevailing Wage requirements and the predetermined rates in any subcontract or lower tier subcontract for this project.

2.The undersigned certifies that:

(a)Neither he nor his firm, nor any firm, corporation or partnership in which he or his firm has an interest is debarred by the Secretary of Labor and Industry pursuant to Section 11(e) of the PA Prevailing Wage Act, Act of August 15, 1961, P.L. 987 as amended, 43 P.S.§ 165-11(e).

(b)No part of this contract has been or will be subcontracted to any subcontractor if such subcontractor or any firm, corporation or partnership in which such subcontractor has an interest is debarred pursuant to the aforementioned statute.

3.The undersigned certifies that:

(a)the legal name and the business address of the contractor or subcontractor are: _________________________

_________________________________________________________________________________________

(b) The undersigned is:

a single proprietorship

a corporation organized in the state of ______________

 

a partnership

other organization (describe) ____________________________

(c)The name, title and address of the owner, partners or officers of the contractor/subcontractor are:

NA M E

TITLE

A DDRESS

The willful falsification of any of the above statements may subject the contractor to civil or criminal prosecution, provided in the PA Prevailing Wage Act of August 15, 1961, P.L. 987, as amended, August 9, 1963, 43 P.S. § 165.1 through 165.17.

(DATE)

SEAL

LLC-25 REV 10 -03 (Page 2)

(SIGNATURE)

(TITLE)

Taken, sw orn and subscribed bef ore me t his _________ Day

of ___________________________________ A .D., ___________

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