Official Federal Forms > US Department Of Housing And Urban Development
Record Of Employee Interview HUD-11 - Official Federal Forms
| Record Of Employee Interview Form. This is a national form and can be used in US Department Of Housing And Urban Development . |
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Record of Employee Interview U.S. Department of Housing and Urban Development Office of Labor Relations OMB Approval No. 2501-0009 (exp. 10/31/2010) Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. The information is collected to ensure compliance with the Federal labor standards by recording interviews with construction workers. The information collected will assist HUD in the conduct of compliance monitoring; the information will be used to test the veracity of certified payroll reports submitted by the employer. Sensitive Information. The information collected on this form is considered sensitive and is protected by the Privacy Act. The Privacy Act requires that these records be maintained with appropriate administrative, technical, and physical safeguards to ensure their security and confidentiality. In addition, these records should be protected against any anticipated threats or hazards to their security or integrity that could result in substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom the information is maintained. The information collected herein is voluntary, and any information provided shall be kept confidential. 1a. Project Name 2a. Employee Name 1b. Project Number 2b. Employee Phone Number (including area code) 1c. Contractor or Subcontractor (Employer) 2c. Employee Home Address & Zip Code 2d. Verification of identification? Yes 3a. How long on this job? 3b. Last date on this job before today? 3c. No. of hours last day on this job? No 4b. Fringe Benefits? Vacation Medical Pension 5. Your job classification(s) (list all) --- continue on a separate sheet if necessary Yes Yes Yes No No No 4c. Pay stub? Yes No 4a. Hourly rate of pay? 6. Your duties 7. Tools or equipment used CONFIDENTIAL Y N 10. Are you paid at least time and ½ for all hours worked in excess of 40 in a week? 11. Have you ever been threatened or coerced into giving up any part of your pay? 12b. Date Y N 8. Are you an apprentice or trainee? 9. Are you paid for all hours worked? 12a. Employee Signature 13. Duties observed by the Interviewer (Please be specific.) 14. Remarks 15a. Interviewer name (please print) 15b. Signature of Interviewer 15c. Date of interview Payroll Examination 16. Remarks 17a. Signature of Payroll Examiner 17b. Date Previous editions are obsolete Form HUD-11 (08/2004) American LegalNet, Inc. www.FormsWorkflow.com
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