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The WH-58 form plays a crucial role in ensuring that employees receive fair compensation for their work. This document is issued by the U.S. Wage and Hour Division of the Department of Labor and serves as a receipt for payment of back wages, employment benefits, or other compensation. It is particularly relevant for individuals who have been underpaid or have not received their rightful earnings. The form includes essential information such as the employee's name, the employer's details, and the specific period for which the payment is being made. It also outlines the amount of back wages received, along with any legal deductions. Importantly, the WH-58 form notifies employees about their rights under the Fair Labor Standards Act (FLSA). By accepting the payment indicated on the form, employees acknowledge that they are giving up their right to sue for unpaid wages or overtime for the specified time period. Employers must also certify that they have paid the employee the amount listed, reinforcing accountability in wage distribution. Understanding the WH-58 form is vital for both employees and employers, as it helps to maintain transparency and compliance in wage practices.

Wh 58 Example

 

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 Davis-Bacon and Related Act(s)

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 2-year statute of limitations applies to the recovery of back wages. Do not sign this receipt unless you have actually received this payment in the amount indicated above of the wages and other compensation due you.

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 above-named

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 WH-58 (Rev. September 2010)

Date: 10/05/2012 9:28:30 AM

Case ID: 1623334

Page 1
Click for Wh 58 File

File Breakdown

Fact Name Description Governing Law(s)
Purpose of WH-58 The WH-58 form serves as a receipt for payment of back wages, employment benefits, or other compensation owed to an employee. Fair Labor Standards Act (FLSA)
Employee Rights By accepting the payment indicated on the WH-58, an employee waives the right to sue for unpaid minimum wages or overtime compensation for the specified period. Fair Labor Standards Act (FLSA)
Payment Calculation The payment amount on the WH-58 is calculated based on findings from an investigation conducted by the Wage and Hour Division. Fair Labor Standards Act (FLSA)
Certification Requirement The employer must certify that the payment has been made in full to the employee, ensuring compliance with wage laws. Fair Labor Standards Act (FLSA)

Guide to Using Wh 58

Completing the WH-58 form is a straightforward process that requires careful attention to detail. This form is essential for documenting the acceptance of back wages or other compensation due to an employee. After filling out the form, it is important to keep a copy for personal records and submit it as directed.

  1. Begin by entering your full name in the designated space, ensuring it is typed or printed clearly.
  2. Provide the name and location of your employer, including the full address. In this case, it would be Lockheed Martin Corporation, 599 Tomales Road, Petaluma.
  3. Indicate the period for which you are receiving payment. Write the start and end dates of the workweeks, such as “beginning with the workweek ending 05/07/2011 through the workweek ending 03/10/2012.”
  4. Fill in the gross amount of back wages you received. For example, enter “$0,555.13.”
  5. If applicable, list any legal deductions or other amounts paid, specifying the type of payment.
  6. Calculate and enter the net amount received after deductions.
  7. Read the notice regarding your rights under the Fair Labor Standards Act (FLSA). Ensure you understand the implications of accepting this payment.
  8. Sign the form in the designated area to confirm that you have received the payment as indicated.
  9. Provide your address and the date of signing the form.
  10. For the employer’s section, the employer or authorized representative must sign and certify the payment made to you.

Get Answers on Wh 58

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 confirms that an employee has received payment for back wages, employment benefits, or other compensation. This payment is based on findings from a Wage and Hour Division investigation.

Who needs to fill out the WH-58 form?

The WH-58 form is typically filled out by employees who have received back wages or other compensation due to them. Employers or their authorized representatives also need to certify the payment on this form.

What information is included on the WH-58 form?

The form includes:

  • The employee's name
  • The employer's name and location
  • The period during which the wages were owed
  • The gross amount of back wages
  • Legal deductions
  • The net amount received
  • Notice regarding the Fair Labor Standards Act (FLSA)

What does the notice under the Fair Labor Standards Act mean?

The notice informs the employee that by accepting the payment, they give up their right to sue for unpaid minimum wages or overtime for the specified period. This includes any potential liquidated damages, attorney's fees, and court costs.

By signing the WH-58 form, the employee acknowledges that they have received the payment indicated. It is crucial not to sign the form unless the payment has been received. Signing falsely can lead to penalties, including fines or imprisonment.

How long does an employee have to recover back wages?

Generally, there is a two-year statute of limitations for recovering back wages under the Fair Labor Standards Act. This means that employees must take action within two years of the date the wages were due.

What happens if an employee disagrees with the amount paid?

If an employee disagrees with the amount paid, they should not sign the WH-58 form. Instead, they should contact the Wage and Hour Division to discuss their concerns and explore their options for resolution.

Can the WH-58 form be used for different types of compensation?

Yes, the WH-58 form can be used for various types of compensation, including back wages, employment benefits, and other compensation owed to the employee. The specific type of compensation should be indicated on the form.

Common mistakes

Filling out the WH-58 form can be a straightforward process, but several common mistakes can lead to complications. One frequent error is failing to provide the correct name of the employee. The form requires the employee’s name to be typed or printed clearly. Omitting or misspelling the name can result in delays or issues with payment.

Another mistake often made is not including the correct dates for the work period. The form specifies a range of dates, and it is essential to ensure that these dates accurately reflect the workweek. Incorrect dates can lead to misunderstandings about the amount owed and the eligibility for compensation.

Many individuals overlook the importance of accurately reporting the gross amount of back wages. It is crucial to ensure that the figure is entered correctly, as any discrepancies can complicate the processing of the claim. Additionally, failing to specify other amounts paid can create confusion regarding the total compensation received.

Signing the form without having received the payment indicated is a critical mistake. The employee must confirm that they have actually received the payment before signing. Signing prematurely can forfeit the right to pursue further claims for unpaid wages.

Another common error is neglecting to check the appropriate Act(s) under which the payment is being made. This section is vital as it outlines the legal basis for the compensation. Not marking the correct box can lead to complications in the processing of the claim.

Inaccurate or incomplete employer certification is also a significant issue. The employer must sign and date the form, certifying that the payment has been made. If this section is not filled out correctly, it may result in delays in payment or further legal complications.

Some individuals fail to provide a complete address on the form. A clear and complete address is necessary for proper record-keeping and communication. Incomplete information can hinder the processing of the claim.

Another mistake is not being aware of the implications of accepting the payment. The notice under the Fair Labor Standards Act indicates that accepting the payment means giving up the right to sue for unpaid wages. It is important to understand this before signing.

Finally, individuals sometimes do not keep a copy of the completed form for their records. Retaining a copy can be beneficial for future reference and in case any disputes arise regarding the payment. Keeping thorough documentation is always advisable.

Documents used along the form

The WH-58 form is a critical document used by employees to acknowledge the receipt of back wages or other compensation. However, it often accompanies several other forms and documents that provide additional context or information related to wage and hour claims. Below is a list of these documents, along with a brief description of each.

  • Form WH-1: This is the initial complaint form filed by employees to report violations of wage and hour laws. It serves as a starting point for investigations by the Wage and Hour Division.
  • Form WH-2: This form is used to request a review of the Wage and Hour Division's findings. Employees can submit this form if they believe their case requires further examination.
  • Form WH-3: This document is a wage claim form that employees fill out to detail their unpaid wages. It includes information about hours worked, pay rates, and other relevant details.
  • Form WH-4: This is a request for a determination of the employee's eligibility for overtime pay. It helps clarify whether an employee qualifies for overtime under the Fair Labor Standards Act.
  • Form WH-5: This form is used to report any discrepancies in wage payments. Employees can document issues such as underpayment or failure to receive promised wages.
  • Form WH-6: This document serves as a notice to employers about potential wage violations. It alerts employers to investigate and rectify any issues before formal claims are made.
  • Form WH-7: This form is utilized for documenting any retaliation claims against employers. Employees can report instances where they faced adverse actions for asserting their rights under wage laws.

These documents work together to ensure that employees have a clear path for addressing wage and hour disputes. They help facilitate communication between employees and employers while providing a structured process for resolving issues related to compensation.

Similar forms

  • Form WH-56: This form is used for wage claim applications. Like WH-58, it documents wage disputes and the amounts owed to employees.
  • Form WH-55: This is a notice of employee rights under the Fair Labor Standards Act. It informs employees about their rights, similar to the WH-58's notice section.
  • Form WH-14: This form is for filing a complaint regarding unpaid wages. It shares the goal of ensuring employees receive fair compensation.
  • Form WH-100: This is an application for a wage determination under the Davis-Bacon Act. It similarly seeks to establish fair wage standards.
  • Form WH-150: This is a request for a review of wage determinations. Like WH-58, it involves the Wage and Hour Division's oversight of wage issues.
  • Form WH-4: This is a request for tax withholding allowances. It relates to employee compensation and deductions, similar to the financial aspects of WH-58.
  • Form WH-3: This is a report of the employer’s wage and hour practices. It helps ensure compliance with wage laws, much like the WH-58 form.
  • Form WH-2: This is a record of employee hours worked. It supports wage calculations, similar to the data used in WH-58.
  • Form WH-1: This is a wage and hour complaint form. It is used to report wage violations, aligning with the purpose of the WH-58.
  • Form WH-1500: This is a request for information about wage claims. It assists employees in understanding their rights, just as WH-58 does.

Dos and Don'ts

When filling out the WH-58 form, it's important to follow specific guidelines to ensure accuracy and compliance. Below is a list of things to do and avoid.

  • Do provide your full name as it appears on official documents.
  • Do enter the correct name and address of your employer.
  • Do accurately state the period for which you are claiming wages.
  • Do clearly indicate the gross amount of back wages received.
  • Do read the notice regarding your rights under the Fair Labor Standards Act.
  • Do sign and date the form only after confirming receipt of payment.
  • Don't leave any sections blank; all information must be completed.
  • Don't provide false information or misrepresent any details.
  • Don't sign the form if you have not received the payment stated.
  • Don't ignore the penalties for false statements; they are serious.
  • Don't forget to keep a copy of the completed form for your records.
  • Don't rush through the form; take your time to ensure accuracy.

Misconceptions

Understanding the WH-58 form is crucial for employees who have received back wages or compensation. However, several misconceptions can lead to confusion. Here are eight common misunderstandings about the WH-58 form:

  • The WH-58 form is only for minimum wage violations. This form applies to various compensation issues, not just minimum wage. It can address unpaid overtime, employment benefits, and other forms of compensation.
  • Signing the WH-58 form means I forfeit all my rights. While signing the form does mean you accept the payment and give up the right to sue for those specific unpaid wages, it does not eliminate all your rights regarding future claims or issues.
  • The amount listed on the WH-58 form is final and cannot be disputed. Employees can dispute the amount if they believe it is incorrect. It’s important to review the details before signing.
  • The WH-58 form guarantees that I will receive all the wages owed to me. The form indicates payment has been made based on an investigation, but it does not guarantee that all owed wages have been fully paid.
  • Once I sign the WH-58 form, I cannot take any further action. You can still pursue other claims or actions related to different periods or types of compensation not covered by this payment.
  • The WH-58 form is only applicable to employees of large companies. This form can apply to employees of various organizations, regardless of size, as long as they are covered under the relevant labor laws.
  • The WH-58 form is only relevant for federal employment. While it is issued by the U.S. Department of Labor, it applies to employees in both federal and non-federal sectors, as long as they are covered under the Fair Labor Standards Act and other applicable laws.
  • I cannot receive assistance in understanding the WH-58 form. Employees are encouraged to seek guidance from legal advisors or labor organizations if they have questions about the form or their rights.

It’s essential to clarify these misconceptions to ensure that employees understand their rights and the implications of the WH-58 form. Knowledge empowers individuals to make informed decisions regarding their employment compensation.

Key takeaways

When dealing with the WH-58 form, understanding its purpose and proper usage is crucial. Here are key takeaways to consider:

  • Purpose of the Form: The WH-58 form is used to acknowledge the receipt of back wages or other compensation determined by the Wage and Hour Division of the U.S. Department of Labor.
  • Importance of Accuracy: Ensure that all information, including the amount received and the employer's details, is accurately filled out. Errors can lead to complications in future claims.
  • Legal Implications: Signing the form means you waive your right to sue for unpaid wages for the specified period. Understand this commitment before signing.
  • Statute of Limitations: Be aware that a two-year statute of limitations typically applies for recovering back wages under the Fair Labor Standards Act (FLSA).
  • Employer Certification: The employer must certify that the payment has been made in full. This adds an additional layer of accountability for both parties.