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Fringe Benefit Statement free printable template

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Last updated May 12, 2026 · Reviewed by pdfFiller editorial team

Key takeaways

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  • The Fringe Benefit Statement details hourly rates and types of benefits provided to employees on federal or federally-assisted construction projects.
  • Contractors and subcontractors subject to the Davis-Bacon and Related Acts use this form to substantiate their certified payroll submissions.
  • The document requires detailed company and contract information along with specific hourly rates for health, pension, and other fringe benefits.
  • An authorized representative of the contractor or subcontractor must sign the statement to certify the accuracy of the benefit calculations.
  • Submit this statement with the first certified payroll and whenever fringe benefit plans or rates change during the project.
  • Failure to provide accurate fringe benefit reporting can lead to contract payment withholding, termination, or debarment from future federal contracts.

What is Fringe Benefit Statement?

Fringe Benefit Statement is a supporting document used by contractors and subcontractors on federal or federally-assisted construction projects to detail the hourly rates and types of fringe benefits provided to their employees. Its primary purpose is to ensure full compliance with prevailing wage requirements as established by the Davis-Bacon and Related Acts. By providing this breakdown, employers demonstrate how they meet their obligations, specifically detailing contributions to health insurance, pension plans, and other bona fide benefits that supplement basic hourly wages.

This document captures essential data including company information, contract specifics, and a granular breakdown of hourly rates for various fringe benefits. While not a single standardized federal form, a fringe benefit statement template is often required to be submitted with the first certified payroll and whenever benefit rates change. It serves as the necessary explanation for the method of computing benefits reported on Form WH-347, allowing contracting agencies to verify that the total compensation package satisfies legal mandates for the project.

This document is typically required by federal or state contracting agencies in accordance with Davis-Bacon and Related Acts regulations.

Who needs the Fringe Benefit Statement — and who doesn't

Not everyone files Fringe Benefit Statement. The checklist below tells you whether it applies to your situation — and points you to the right alternative if it doesn't.

You need this Fringe Benefit Statement if…

  • You are a contractor or subcontractor performing work on a federal or federally-assisted construction project subject to the Davis-Bacon and Related Acts.
  • You provide bona fide fringe benefits to your employees as part of their compensation package instead of paying the entire prevailing wage in cash.
  • You must submit a supporting document for your certified payroll that explains the specific method used to compute fringe benefit rates.
  • Changes have occurred to your existing fringe benefit plans or hourly contribution rates that require updated documentation for the contracting agency.

You do not need this Fringe Benefit Statement if…

  • Your federal or federally-assisted construction contract is valued at less than $2,000.
  • You fulfill your total prevailing wage obligations by paying the entire amount, including the fringe benefit portion, as cash wages directly to your employees.
  • You are performing work on a project that is not subject to the Davis-Bacon and Related Acts.

Why you need the Fringe Benefit Statement

Why people fill out Fringe Benefit Statement, and what tends to go wrong when they don't.

  • Maintain Regulatory Compliance Completing this statement ensures adherence to the Davis-Bacon and Related Acts. Proper reporting helps your company avoid severe penalties, such as the withholding of contract payments, contract termination, or debarment.
  • Validate Payroll Calculations This document provides a detailed breakdown of hourly costs for benefits like health insurance and pensions. It serves as the required explanation for fringe benefit figures reported on your certified payroll.
  • Simplify Document Submission You can use pdfFiller to fill, eSign, and share this statement with contracting agencies. The platform allows you to manage your construction documents digitally, ensuring your records are organized and accessible.

Fringe Benefit Statement vs. similar documents

Fringe Benefit Statement gets mixed up with similar documents more than most. Here's how to tell them apart, and what filing the wrong one actually costs.

Comparison criteria Fringe Benefit Statement Form WH-347
Purpose Details hourly rates and types of benefits. Primary weekly certified payroll report for contractors.
When to use First payroll submission or when rates change. Weekly for federal construction projects over $2,000.
Signatures required Signed by an authorized company representative. Signed by contractor, subcontractor, or their agent.
Filing Attached to the first certified payroll submission. Submitted weekly within seven days of payday.
Governing reference Davis-Bacon and Related Acts. Davis-Bacon and Related Acts.

What each section of Fringe Benefit Statement means

Every section explained — what it's asking, the records you'll need on hand, and the mistakes that most often cause a rejection or follow-up request.

Company Information Enter the contractor or subcontractor's legal business name and contact details to identify the employer responsible for the construction project and employee benefit contributions.
Contract Information Provide specific details about the federal or federally-assisted project, including the contract number and the location where the construction work is being performed.
Hourly Benefit Rates Report the calculated hourly costs for various fringe benefits such as health insurance, pension plans, and vacation pay to substantiate prevailing wage compliance.
Authorized Signature A company representative must sign and date the document to certify that the provided breakdown of fringe benefits and hourly rates is accurate and complete.

How to fill out Fringe Benefit Statement using pdfFiller

A walkthrough from the first field to the signature line. With your records in front of you, most people finish in under ten minutes.

  1. Click Get Form to open Fringe Benefit Statement in the pdfFiller editor Access the document immediately to start editing your statement online from any device without needing to install additional software or plugins for your browser.
  2. Input Company Information Select the text fields in the first section to type in your business name, address, and other identifying details required for the payroll fringe benefit form.
  3. Enter Contract Information Click on the designated areas to provide specific details regarding the federal or federally-assisted construction contract this statement supports, ensuring all project identifiers are accurate.
  4. Detail Hourly Benefit Rates Fill out the fields for reporting hourly rates for various fringe benefits, such as health and welfare, pension, or vacation pay, to substantiate your payroll records.
  5. Review the Report Proofread your entries and use editing tools to make any necessary corrections to the company fringe benefit report before finalizing the document for submission to the agency.
  6. Add a Signature Navigate to the Signature Section and use the Sign tool to create and apply a legally binding e-signature, fulfilling the requirements for an authorized representative's validation.
  7. Save and Share Once complete, click Done to save your progress; you can then send the finished PDF via email, share it by link, or fax it directly from the platform.
  8. Manage Securely pdfFiller keeps your documents in secure encrypted storage and is compliant with GDPR, SOC 2, and PCI DSS, providing a safe environment for managing sensitive business forms.

Deadlines, key dates & penalties for Fringe Benefit Statement

When Fringe Benefit Statement is due, what late filing actually costs, and how to request more time if you need it.

Filing Deadline The Fringe Benefit Statement must be attached to the first certified payroll submitted for a project and updated whenever changes occur to the fringe benefit plans or rates.
Submission Frequency Certified payrolls are generally due on a weekly basis, within seven days after the regular pay date.
Penalties for Non-Compliance Failure to comply with Davis-Bacon Act requirements, including proper fringe benefit reporting, can result in the withholding of contract payments, contract termination, and debarment from future federal contracts.

State variations of Fringe Benefit Statement

While the requirement to document fringe benefits is established under the federal Davis-Bacon and Related Acts, the specific format or template for a Fringe Benefit Statement can vary significantly depending on the state or the local contracting agency. Many states have their own prevailing wage laws and specific reporting versions of this statement that contractors must use to remain compliant with regional labor regulations.

Alabama
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California
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Delaware
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New Mexico
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Ohio
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Pennsylvania
Rhode Island
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Tennessee
Texas
Utah
Vermont
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Washington
West Virginia
Wisconsin
Wyoming

Related content

The forms, guides, and worksheets most filers reach for alongside Fringe Benefit Statement.

Key terms used in Fringe Benefit Statement

A one-sentence glossary of the Fringe Benefit Statement terms and concepts you'll see throughout this guide.

Fringe Benefits
Additional compensation provided to employees beyond base wages, such as health insurance, pensions, life insurance, and vacation pay.
Davis-Bacon and Related Acts (DBRA)
Federal laws requiring payment of local prevailing wages and fringe benefits on public works construction projects.
Certified Payroll
A weekly report submitted by contractors on federal projects to verify compliance with prevailing wage requirements.
Prevailing Wage
The minimum hourly rate of wages and benefits determined by the Department of Labor for specific worker classifications in a locality.
Bona Fide Fringe Benefit Plan
A qualifying benefit program funded by employer contributions that meets specific federal requirements for inclusion in prevailing wage calculations.
Hourly Rate
The calculated cost per hour for each fringe benefit, used to substantiate total compensation reported on certified payroll documents.

Frequently asked questions about Fringe Benefit Statement

Quick answers to the questions we hear most often about completing the Fringe Benefit Statement.

A Fringe Benefit Statement is a document used by contractors on federal construction projects to detail the hourly rates and types of benefits provided to employees. This statement ensures compliance with the Davis-Bacon and Related Acts by breaking down costs for items like health insurance, pensions, and vacation pay. Using pdfFiller, businesses can easily complete and manage these financial reports online.

Contractors and subcontractors performing work on federal construction projects subject to Davis-Bacon and Related Acts must submit this statement if they provide fringe benefits. It serves as a supporting document for certified payroll submissions. However, contractors who pay the full prevailing wage entirely in cash or work on projects under $2,000 are generally exempt from this specific reporting requirement.

The Fringe Benefit Statement must be attached to the first certified payroll submitted for a project and whenever changes occur to benefit plans or rates. Since certified payrolls are typically due weekly within seven days of the pay date, keeping an updated template is essential. You can use pdfFiller to quickly update and share the modified document with the relevant contracting agency.

A Fringe Benefit Statement typically requires company information, contract details, and a breakdown of hourly rates for specific benefits like health insurance and pensions. It specifically lists the costs for various bona fide benefits to demonstrate that total compensation meets prevailing wage standards. With pdfFiller, you can utilize OCR and text extraction to pull this data from existing records into your digital form.

Form WH-347 is the primary weekly payroll report, whereas the Fringe Benefit Statement is a supporting document that explains the specific benefit calculations reported on that payroll. While WH-347 tracks hours and total wages, the statement provides the necessary explanation of the method of computing those benefits. Both documents can be signed and sent securely through pdfFiller’s encrypted platform.

Failure to comply with fringe benefit reporting requirements can result in the withholding of contract payments, contract termination, or debarment from future federal contracts. Accurate documentation is vital for demonstrating compliance with legal authorities like 29 CFR Part 5. pdfFiller helps users maintain compliance by storing finished PDFs in secure, encrypted storage that meets SOC 2 and PCI DSS standards.

An authorized representative of the contractor or subcontractor must sign the Fringe Benefit Statement to certify the accuracy of the reported benefit rates. This signature is often implicitly linked to the certified payroll’s Statement of Compliance. You can add a legally binding e-signature to your document using pdfFiller before sending it via link or email to the project's contracting officer.

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