Application for Authority to Employ Workers with Disabilities at Subminimum Wages

• Legal Form Number: WH-226
• Issuer: Wage and Hour Division
• Section: U.S. Department of Labor

_______________________________________________________

________________

WH-226

Application for Authority to Employ Workers with

Disabilities at Subminimum Wages

U.S. Department of Labor

Wage and Hour Division

230 S. Dearborn Street, Room 530

Chicago, IL 60604

OMB NO: 1235-0001

Expires: 07-31-2027

This is an application for the authority to employ workers with disabilities at subminimum wage rates under the Fair Labor Standards Act (FLSA), Walsh-Healey

Public Contracts Act (PCA), or McNamara-O’Hara Service Contract Act (SCA).

Please submit one copy of the completed form, and any attachments, to the address shown above. Please do not staple the form or accompanying documents.

Retain a completed copy for your records. A certificate may not be granted by the Department of Labor unless a properly completed application has been

received and approved. See 29 C.F.R. part 525.

Instructions for completing this form are on pages 6-9.

1. REPRESENTATIONS AND WRITTEN ASSURANCES

I certify that I have read this form and to the best of my knowledge and belief, all answers and information given in the application and attachments are true; that

the representations set forth in support of this application to obtain or continue the authorization to pay workers with disabilities at subminimum wage rates are

true; and I acknowledge that the authorization, if issued or continued, is subject to revocation in accordance with the provisions of 29 C.F.R. part 525.

I represent that as set forth in the regulations governing the employment of workers with disabilities, the following conditions exist and will continue to exist:

1. Workers employed under the authority in 29 C.F.R. part 525 have disabilities for the work to be performed;

2. Wage rates paid to workers with disabilities under the authority in 29 C.F.R. part 525 are commensurate with those paid experienced workers, who do not

have disabilities, in industry in the vicinity for essentially the same type, quality, and quantity of work;

3. The operations are and will continue to be in compliance with the FLSA, PCA, SCA, and Contract Work Hours and Safety Standards Act (CWHSSA), an

overtime statute for Federal contract work, as applicable;

4. No deductions will be made from the commensurate wages earned by a patient worker to cover the cost of room, board or other services provided by the

facility;

5. Records required under 29 C.F.R. part 525 with respect to documentation of disability, productivity, work measurements or time studies, and prevailing

wage surveys will be maintained.

Further, I certify that:

1. The wage rates of all hourly-rated employees paid in accordance with FLSA section 14(c) will be reviewed at least every six months; and

2. Wages paid to all employees under FLSA section 14(c) will be adjusted at periodic intervals, at least once a year, to reflect changes in the prevailing wage

paid to experienced workers, who do not have disabilities, employed in the vicinity for essentially the same type of work.

SIGNATURE OF AUTHORIZED REPRESENTATIVE

Name (First and Last Name) (print or type) Title

Signature Date (mm/dd/yyyy)

2. APPLICATION TYPE

(a) This is a request for authority to employ workers with disabilities in a

(check all boxes that apply):

Community Rehabilitation Program (Work Center)

Hospital / Residential Care Facility (Patient Workers)

School Work Experience Program (SWEP)

Business Establishment

(b) This is (check one):

USDOL USE ONLY

/ / / /

Certicate Number Effective Date Expiration Date

RO _______________________ DO _________________________

Remarks _______________________________________________

Employees_________________ Paying SMWs? Yes No

Number of sites to receive a certicate ________________________

Issued Returned Denied Withdrawn

Revoked Date of decision / /

Print certicate? Yes No WS

Form WH-226

Initial Application Renewal Application

Has this employer ever previously applied for a 14(c) certificate?

Yes No

Has this employer ever previously held a 14(c) certificate?

Yes No

If YES, list the most recently held certificate number:

_____________________________________________________

REV 07/2024

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