Free Delaware Payroll Report PDF Template Fill Out Form Here

Free Delaware Payroll Report PDF Template

The Delaware Payroll Report form is a crucial document that contractors and subcontractors must submit to the Delaware Department of Labor. This report details the wages paid to employees working on public projects, ensuring compliance with state prevailing wage laws. By accurately completing this form, employers affirm that all workers have received their due compensation and that the information provided is truthful and complete.

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Outline

The Delaware Payroll Report form is an essential document used by contractors and subcontractors engaged in public projects within the state. This form serves multiple purposes, including the accurate reporting of employee wages and hours worked, as well as ensuring compliance with prevailing wage laws. Each report requires detailed information about the project, including the project location, contract number, and the date of the prevailing wage determination. Employers must list the names, social security numbers, and classifications of employees, alongside their total hours worked and gross wages earned for each pay period. The form also mandates the disclosure of deductions made from wages, ensuring that only permissible deductions are reported. Additionally, employers must confirm that all employees have been paid their full wages and that any apprentices are registered in a legitimate apprenticeship program. Failure to submit this report weekly can result in significant fines, emphasizing the importance of accuracy and timeliness. The form concludes with a certification statement, which must be signed and notarized, affirming the truthfulness of the reported information.

Preview - Delaware Payroll Report Form

Contractor Name*
DIA—Oce of Construcon Industry Enforcement
DEceredpayroll@delaware.gov
252 Chapman Rd. STE 210 | Newark, DE 19702 | 302-318-2798
Project Name*
*Required elds
Employee Name* Employee Address*
Employee Address*
Employee Address*
Employee Address*
Employee Name*
Employee Name*
Employee Name*
Social Security*
Social Security*
Social Security*
Social Security*
Job Title*
Job Title*
Job Title*
Job Title*
Journeyman
Journeyman
Journeyman
Journeyman
Classicaon*
Classicaon*
Classicaon*
Classicaon*
Sex*
Sex*
Sex*
Sex*
Race*
Race*
Race*
Race*
Foreman
Foreman
Foreman
Foreman
Apprence
Apprence
Apprence
Apprence
% Rate
Superintendent
Superintendent
Superintendent
Superintendent
Owner
Owner
Owner
Owner
Project Locaon(s)* Contract # / Project #* Payroll Number* Final Payroll
Contract Registraon Number*Business Address* FEIN*
PROJECT INFORMATION
EMPLOYEE INFORMATION
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
M T W T F S S TTL HRS RATE THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S STTL HRS RATE THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
M T W T F S S TTL HRS
RATE
THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S S
TTL HRS
RATE
THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
PAYROLL REPORT
S = Straight O = OvermeS = Straight O = OvermeS = Straight O = OvermeS = Straight O = Overme
% Rate
% Rate
% Rate
OTHER/
SPECIFY
OTHER/
SPECIFY
OTHER/
SPECIFY
OTHER/
SPECIFY
Date Wages Due & Paid* Week Ending Date*
 
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
DE-9999-999999999
99-9999999
On-site
1/1/2025
1/1/2025
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
DIA—Oce of Construcon Industry Enforcement
DEceredpayroll@delaware.gov
252 Chapman Rd. STE 210 | Newark, DE 19702 | 302-318-2798
Employee Name* Employee Address*
Employee Address*
Employee Address*
Employee Address*
Employee Address*
Employee Name*
Employee Name*
Employee Name*
Employee Name*
Social Security*
Social Security*
Social Security*
Social Security*
Social Security*
Job Title*
Job Title*
Job Title*
Job Title*
Job Title*
Journeyman
Journeyman
Journeyman
Journeyman
Journeyman
Classicaon*
Classicaon*
Classicaon*
Classicaon*
Classicaon*
Sex*
Sex*
Sex*
Sex*
Sex*
Race*
Race*
Race*
Race*
Race*
Foreman
Foreman
Foreman
Foreman
Foreman
Apprence
Apprence
Apprence
Apprence
Apprence
% Rate
Superintendent
Superintendent
Superintendent
Superintendent
Superintendent
Owner
Owner
Owner
Owner
Owner
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S STTL HRS RATE THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S S
TTL HRS
RATE
THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S STTL HRS RATE THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S STTL HRS RATE THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
HRS WORKED EACH DAY/DATE GROSS AMT EARNED DEDUCTIONS
MTWT F S STTL HRS RATE THIS PROJECT THIS WEEK FICA FED TAX STATE TAX TTL DEDUCTIONS NET WAGES TTL FRINGE BENEFITS / HR
S
O
S = Straight O = OvermeS = Straight O = OvermeS = Straight O = OvermeS = Straight O = OvermeS = Straight O = Overme
% Rate
% Rate
% Rate
% Rate
OTHER/
SPECIFY
OTHER/
SPECIFY
OTHER/
SPECIFY
OTHER/
SPECIFY
OTHER/
SPECIFY
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
Complete Fringe Benefits Page to
populate this field
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
000-00-0000
0
0
0
0
0
0
0
EMPLOYEE NAME
HEALTH/
WELFARE
VACATION/
HOLIDAY/
SICK
APPRENTICESHIP/
TRAINING
PENSION/
401K
OTHER
BENEFIT
NAME AND ADDRESS OF FRINGE BENEFIT PLAN OR PROGRAM ADMINISTRATOR
USDOL FILING #/
EIN
THIRD-PARTY TRUSTEE/
CONTRACT PERSON
DELAWARE PREVAILING WAGE INFORMATION
Fringe benets may be considered in determining whether an employer has met his/her prevailing wage obligaons.
However, any contribuons made by employees must be voluntary. The only fringe benets which the Delaware
Department of Labor will recognize are the following:
List only those fringe benefits:
For which the employer has paid; and which have been used to offset the full prevailing wage rate.
(See Delaware Prevailing Wage Regulations for explanation of how hourly value of benefits is the be computed.)
To calculate the cost per hour              .
» Health Insurance
» Life Insurance
» Disability Insurance
» Rerement Benets
» Vacaon Pay
» Holiday Pay
» Sick Leave Pay
» Bereavement Leave
» Education Benefits related to apprenticeship and training programs
» Supplemental Unemployment Benefit
DIA—Oce of Construcon Industry Enforcement
DEceredpayroll@delaware.gov
252 Chapman Rd. STE 210 | Newark, DE 19702 | 302-318-2798
I,
do hereby state:
1. That I pay or supervise the payment of persons employed by
that during the payroll period commencing on the day of , 20
and ending on the day of , 20 all persons employed
on said project have been paid the full weekly wages earned, that no rebates have been or will be
made either directly or indirectly to or on behalf of the contractor or subcontractor from the full
weekly wages earned by any person and that no deductions have been made either directly or
indirectly from the full wages earned by any person, other than permissible deductions as defined in
the prevailing wage regulations of the State of Delaware.
2. That any payrolls otherwise under this contract required to be submitted for the above period
are correct and complete; that the wage rates for laborers or mechanics contained therein are not
less than applicable wage rates contained in any wage determination incorporated into the contract;
that the classifications set forth therein for each laborer or mechanic conform with the work
performed.
Date
Name of signatory party Title
Sworn to and subscribed before me, a notary public,
this
day of , A.D. 20
State of
Signature
Contractor Project Name
Notary Public
County of
3. That any apprences employed in the above period are duly registered in a bona de apprenceship
program registered with a state apprenceship agency recognized by the Bureau of Apprenceship and
Training, United States Department of Labor, and that the worksite rao of apprences to mechanics
does not exceed the ratio permitted by the prevailing wage regulations of the State of Delaware.
I hereby certify that the foregoing information is true and correct to the best of m knowledge and
belief. I realize that making a false statement under oath is a crime in State of Delaware.
on the:
An employer who fails to submit sworn payroll informaon to the Department of Labor weekly shall be
subject to nes of $1,000 and $5,000 for each violaon.
!
DIA—Oce of Construcon Industry Enforcement
DEceredpayroll@delaware.gov
252 Chapman Rd. STE 210 | Newark, DE 19702 | 302-318-2798
1/1/2025
31
December
26
31
December
26
31
December
26
↓ Delaware Payroll Report PDF

Form Details

Fact Name Description
Governing Law The Delaware Payroll Report form is governed by the Delaware Prevailing Wage Regulations.
Purpose This form is used to report payroll information for contractors and subcontractors working on public projects in Delaware.
Submission Frequency Employers must submit the payroll report weekly to the Delaware Department of Labor.
Information Required The form requires details such as employee names, hours worked, wages, and deductions.
Consequences of Non-Compliance Failure to submit accurate payroll reports may result in fines ranging from $1,000 to $5,000 for each violation.
Certification The signatory must certify that the information provided is accurate and complete under penalty of perjury.
Fringe Benefits Employers must list only those fringe benefits that have been paid and used to offset the prevailing wage rate.
Notary Requirement The completed form must be sworn to and subscribed before a notary public.
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Free Delaware Payroll Report PDF Template

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