Content Overview
The WH-58 form plays a crucial role in the landscape of wage and hour regulations in the United States. Issued by the Wage and Hour Division of the U.S. Department of Labor, this form serves as a receipt for employees who have received back wages, employment benefits, or other forms of compensation. It is particularly significant for individuals who have been part of an investigation conducted by the Wage and Hour Division, ensuring that they receive the compensation owed to them based on the findings of that investigation. The form details essential information, including the name of the employee, the employer's information, and the specific period for which compensation is being claimed. It also outlines the gross amount of back wages received, any legal deductions, and the net amount. Importantly, by accepting the payment indicated on the WH-58, employees acknowledge that they relinquish the right to pursue further legal action regarding unpaid wages or overtime for the specified period. The form highlights various acts under which the payment is made, such as the Fair Labor Standards Act and the Family and Medical Leave Act, underscoring the legal framework that governs wage and hour issues. Understanding the WH-58 form is vital for both employees and employers, as it encapsulates the rights and responsibilities involved in wage recovery processes.
Document Preview
|
3NHD |
|
U.S. Wage and Hour Division |
Receipt for Payment of Back Wages, |
U.S. Department of Labor |
Employment Benefits, or Other Compensation |
Wage and Hour Division |
I, _________________Lawrence,_ Kevin |
have received payment of wages, employment benefits, |
(typed or printed name ofemployee) |
|
or other compensation due to me from Lockheed Martin Corporation, 599 Tomales Road, Petaluma,
|
(name and location ofthe establishment) |
|
for the period beginning with the workweek ending |
05/07/2011______________ through the workweek |
|
ending |
03/10/2012 |
, The amount of the payment I received is shown below. |
This payment of wages and other compensation was calculated or approved by the Wage and Hour Division and is based on the findings of a Wage and Hour Division investigation. This payment is required by the Act(s) indicated below in the marked box(es):
П Fair Labor Standards Act1 |
0 Service Contract Act |
Family and Medical Leave Act |
О |
Employee Polygraph Protection Act |
Other |
Migrant and Seasonal Agricultural Worker Protection Act |
|
Contract Work Hours and Safety Standards Act |
|
Gross Amount Back Wages $0,555.13
Legal Deductions
Other Amount Paid
(please specify type)
Net Amount Received
‘NOTICE TO EMPLOYEE UNDER THE FAIR LABOR STANDARDS ACT (FLSA) - Your acceptance of this payment of wages and other compensation due under the FLSA based on the findings of the Wage and Hour Division means that you have given up the right you have to bring suit on your own behalf for the payment of such unpaid minimum wages or unpaid overtime compensation for the period of time indicated above and an equal amount in liquidated damages, plus attorney's fees and court costs under Section 16(b) of the FLSA. Generally, a
Signature of employee |
Date |
Address
EMPLOYER’S CERTIFICATION TO WAGE AND HOUR DIVISION OF THE
DEPARTMENT OF LABOR:
I hereby certify that I have on this (Date) |
paid the |
employee in full covering lost or denied wages or other compensation as stated above.
SignatureTitle
(Employer or authorized representative)
PENALTIES INCLUDING FINES OR IMPRISONMENT ARE PRESCRIBED FOR A FALSE
STATEMENT OR MISREPRESENTATION UNDER U.S. CODE, TITLE 18, SEC. 1001
1. WAGE AND HOUR COPY
Form
Date: 10/05/2012 9:28:30 AM |
Case ID: 1623334 |
Page 1 |
Form Specifications
| Fact Name | Details |
|---|---|
| Purpose | The WH-58 form is used to document the receipt of back wages, employment benefits, or other compensation owed to an employee. |
| Governing Laws | This form is governed by several laws, including the Fair Labor Standards Act (FLSA), Family and Medical Leave Act (FMLA), and others as indicated. |
| Employee Acknowledgment | By signing the WH-58, the employee acknowledges receipt of the specified payment and waives the right to sue for unpaid wages for the indicated period. |
| Statute of Limitations | Generally, a 2-year statute of limitations applies for recovering back wages under the FLSA. |
| Employer Certification | The employer must certify that the payment has been made in full to the employee for lost or denied wages. |
| Legal Consequences | False statements or misrepresentations on this form can lead to penalties, including fines or imprisonment under U.S. Code, Title 18, Sec. 1001. |
| Form Revision Date | The WH-58 form was last revised in September 2010, ensuring it reflects the most current legal requirements. |
Wh 58: Usage Guidelines
After you have gathered all necessary information, filling out the WH-58 form is straightforward. This form is essential for acknowledging the payment of wages or other compensation you have received. Follow these steps carefully to ensure everything is completed correctly.
- Begin by entering your full name in the space provided for the employee's name.
- Next, fill in the name and location of your employer. In this case, it would be Lockheed Martin Corporation, located at 599 Tomales Road, Petaluma.
- Indicate the work period for which you are receiving compensation. Use the dates provided: from the workweek ending 05/07/2011 to the workweek ending 03/10/2012.
- Record the gross amount of back wages you received. This amount is $0,555.13 in the example.
- If there are any legal deductions, specify them in the appropriate section.
- List any other amounts paid, if applicable, and provide details on the type of payment.
- Calculate and write down the net amount received, which is the total after deductions.
- Read the notice regarding your rights under the Fair Labor Standards Act (FLSA) carefully. Make sure you understand that accepting this payment means you give up certain rights.
- Sign and date the form in the designated areas. Your signature confirms you have received the payment as indicated.
- Lastly, the employer or authorized representative must complete their certification by signing and dating the form.
Once you have completed these steps, double-check your entries for accuracy before submitting the form. This will help ensure that everything is in order and that you meet the requirements of the Wage and Hour Division.
Your Questions, Answered
What is the WH-58 form?
The WH-58 form is a receipt issued by the U.S. Wage and Hour Division of the Department of Labor. It serves as proof that an employee has received payment for back wages, employment benefits, or other compensation. This form is typically generated following an investigation by the Wage and Hour Division, ensuring that the payment complies with relevant labor laws, such as the Fair Labor Standards Act.
Who needs to complete the WH-58 form?
Both employees and employers are involved in the completion of the WH-58 form. Employees must sign the form to acknowledge receipt of the payment, while employers or their authorized representatives are responsible for certifying that the payment has been made. It is crucial for both parties to ensure that the information on the form is accurate and complete to avoid any legal issues.
What happens if I sign the WH-58 form?
By signing the WH-58 form, you are acknowledging that you have received the specified payment. However, it is important to understand that this acceptance means you may be waiving your right to pursue further legal action regarding unpaid wages or overtime for the period indicated on the form. This waiver includes the right to claim liquidated damages, attorney's fees, and court costs under the Fair Labor Standards Act.
What are the potential penalties for false statements on the WH-58 form?
Providing false information on the WH-58 form can lead to serious consequences. Under U.S. Code, Title 18, Section 1001, penalties may include fines or imprisonment for anyone who knowingly submits a false statement or misrepresentation. It is essential to ensure that all information provided on the form is truthful and accurate to avoid these severe repercussions.
Common mistakes
-
Failing to provide a complete name. Ensure that the name is typed or printed clearly. Any errors can lead to delays in processing.
-
Not including the correct address. The address of the establishment must be accurate. Double-check for typos.
-
Missing the work period dates. Clearly state the beginning and ending dates of the workweek. Incomplete dates can cause confusion.
-
Incorrectly reporting the gross amount of back wages. Ensure the amount is accurate and matches the calculations provided by the Wage and Hour Division.
-
Omitting legal deductions. If there are any deductions, specify them clearly. Failing to do so may lead to disputes later.
-
Not specifying the type of other amounts paid. If there are additional payments, provide details. This ensures clarity in the records.
-
Signing the receipt without having actually received the payment. Only sign if you have received the stated amount. This protects your rights.
-
Neglecting to read the notice to employee section. Understanding what you are signing is crucial. This section outlines your rights.
-
Failing to include the employer's certification. The employer must certify the payment. Missing this can invalidate the form.
-
Not keeping a copy of the completed form. Always retain a copy for your records. This is important for any future reference or disputes.
Documents used along the form
The WH-58 form is essential for documenting the payment of wages and other compensation as determined by the Wage and Hour Division of the U.S. Department of Labor. Alongside this form, several other documents may be necessary to ensure compliance with labor laws and regulations. Below is a list of related forms and documents that are commonly used in conjunction with the WH-58 form.
- Form WH-1: This form is used to file a complaint regarding wage and hour violations. Employees can report issues such as unpaid wages or overtime pay discrepancies.
- Form WH-2: This document is a record of the hours worked and wages paid to an employee. Employers use it to maintain accurate payroll records.
- Form WH-3: This is a request for an investigation by the Wage and Hour Division. It allows employees to seek a review of their wage and hour concerns.
- Form WH-4: This form serves as a notification of a wage determination made by the Wage and Hour Division. It outlines the findings and decisions regarding wage disputes.
- Form WH-5: This document is an appeal form for employees who wish to contest a wage determination made by the Wage and Hour Division.
- Form WH-6: Employers use this form to provide a detailed account of employee compensation and benefits, ensuring transparency in wage practices.
- Form WH-7: This form is utilized for reporting any changes in employment status that may affect wage calculations, such as promotions or terminations.
- Form WH-8: This is a summary of employee benefits, which may include health insurance, retirement plans, and other compensatory packages.
- Form WH-9: This document is a request for clarification on wage and hour regulations. Employees or employers can use it to seek guidance on compliance issues.
- Form WH-10: This form is a record of any penalties or fines imposed for violations of wage and hour laws, providing a comprehensive overview of compliance history.
Understanding these additional forms can help employees and employers navigate wage and hour issues effectively. Each document plays a vital role in ensuring that rights are upheld and that compensation practices align with federal regulations.
Similar forms
- Form WH-56: This form is used to document the payment of back wages owed to an employee. Similar to WH-58, it outlines the amount owed and the reason for the payment. Both forms ensure that employees acknowledge receipt of their wages and understand their rights under labor laws.
- Form WH-58A: This document serves as a receipt for payments made to employees under the Fair Labor Standards Act. Like WH-58, it details the amounts received and the period covered, providing clarity on wage compensation.
- Form WH-500: The WH-500 is a request for a wage determination. While it does not document payment, it is closely related as it sets the standards for what constitutes fair wages, similar to the calculations made in WH-58.
- Form WH-150: This form is used for filing complaints regarding wage violations. It is similar to WH-58 in that it addresses wage issues, although it focuses on reporting rather than payment confirmation.
- Form WH-1: This is a general complaint form for wage and hour violations. While WH-58 confirms payment, WH-1 is used to initiate claims, connecting the two in the wage recovery process.
- Form WH-226: This form pertains to the employee's right to request an investigation into wage disputes. Both WH-58 and WH-226 are involved in the wage recovery process, ensuring employees are informed of their rights.
- Form WH-2: This form is utilized for reporting the results of wage investigations. Like WH-58, it addresses wage issues but focuses on the findings rather than the acknowledgment of payment.
Dos and Don'ts
When filling out the WH-58 form, it’s essential to approach the task with care. This form is crucial for documenting the payment of wages and other compensation. Here are four key do's and don'ts to ensure that your submission is accurate and effective.
- Do double-check your information. Ensure that your name, employer's name, and payment amounts are correct. Mistakes can lead to delays in processing.
- Do read the instructions carefully. Understanding the requirements will help you complete the form correctly and avoid common pitfalls.
- Don't sign the form unless you have received the payment. Signing prematurely can forfeit your rights to claim unpaid wages in the future.
- Don't leave any sections blank. Incomplete forms may be rejected or returned for additional information, prolonging the process.
Completing the WH-58 form accurately is vital for ensuring that you receive the compensation you are entitled to. Take your time, follow these guidelines, and protect your rights.
Misconceptions
Understanding the WH-58 form is crucial for employees who have received back wages or other compensation. However, several misconceptions can lead to confusion. Here are eight common misunderstandings about this form:
- It's just a receipt. Many people think the WH-58 is merely a receipt for payment. In reality, it also serves as a legal document that affects your rights regarding wage claims.
- Signing means you agree with the amount. Some believe that signing the WH-58 indicates you agree with the payment amount. Instead, it confirms that you have received the specified payment.
- It only applies to certain workers. There is a misconception that the WH-58 is only for specific job types. In truth, it applies to any employee receiving back wages under various labor laws.
- It's only for unpaid wages. Many think the form is solely for unpaid wages. However, it can also cover employment benefits and other compensation.
- You can sign without receiving payment. Some individuals believe they can sign the form without actually receiving payment. This is incorrect; you should only sign if you have received the amount listed.
- It doesn't affect your legal rights. A common myth is that signing the WH-58 does not impact your legal rights. In fact, signing may waive your right to sue for unpaid wages or overtime for the specified period.
- It's a one-time document. Many assume the WH-58 is a one-time document that has no future implications. However, it can influence future claims or legal actions regarding wage disputes.
- All deductions are explained. Some think that all deductions from the payment will be detailed on the form. While some deductions are listed, not all may be fully explained, so it's essential to ask questions if something is unclear.
Being informed about the WH-58 form can help you navigate your rights and responsibilities more effectively. If you have questions, consider reaching out to a legal expert or your employer for clarification.
Key takeaways
Here are key takeaways about filling out and using the WH-58 form:
- The WH-58 form is used to acknowledge receipt of back wages or other compensation from your employer.
- Ensure that all information is accurate, including your name, employer's name, and the period for which you are receiving payment.
- Be aware that signing this form means you are giving up your right to sue for unpaid wages for the specified period.
- The payment amount must be clearly stated, including gross back wages and any legal deductions.
- Understand that a two-year statute of limitations applies to the recovery of back wages under the Fair Labor Standards Act.
- Employers must certify that they have paid the specified amount and that it covers all lost or denied wages.
- False statements or misrepresentations on this form can lead to serious penalties, including fines or imprisonment.