GSA Form 3017: Labor Standards Interview

GSA Form 3017, Labor Standards Interview, is a one-page General Services Administration form, GSA FORM 3017 (REV. 4-84), hosted in GSA's forms library. Its Privacy Act notice says collection of the information is authorized by the U.S. Department of Labor, Standard Labor Provisions, that the person is not required to supply it, and that it will be used only to verify the contractor's compliance with the Davis-Bacon Act, the Contract Work Hours and Safety Standards Act and the Copeland (anti-Kickback) Act.

The form records an interview with an employee on a contract: the contract number, prime contractor, employer, the employee's name and address, work classification, basic hourly rate and supervisor's name, then yes or no answers on hours, overtime pay and fringe benefits. It ends with the interviewer's comments and a section for use by the payroll checker. The form prints no instructions, OMB number or filing address.

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Top of page 1 of GSA Form 3017: Labor Standards Interview, as printed by GSA

What's on GSA Form 3017

Privacy Act notice

Says who authorizes the collection, that the information is not required, and the three laws it is used to verify compliance with.

Contract and employee details

Contract number, prime contractor, employer, employee's name and address (include zip code), work classification, basic hourly rate and supervisor's name.

Employee's comments

Yes or no: work over eight hours per day, work over forty hours per week, paid at least time and a half for overtime hours, and receiving fringe benefits required by the posted wage decisions.

Work details

Deductions other than taxes and social security payment, hours worked on the last workday before the interview, date worked, work performed on the contract, tools used and the date work on the project began.

Certification and signatures

The certification line, the employee's signature and date, and a second signature line printed as INTERVIEW'S SIGNATURE with its date.

Interviewer's comments and payroll check

Whether the employee is properly classified and paid, whether wage rates and poster are displayed, what work the employee was doing when interviewed, and the payroll checker's comparison with payroll data.

How to complete GSA Form 3017

1
Enter the contract and employer
Fill in the contract number, prime contractor and employer.
2
Record the employee's details
Enter the employee's name and address with zip code, work classification, basic hourly rate and supervisor's name.
3
Answer the employee questions
Check yes or no for each of the four questions, then list deductions, hours on the last workday, date worked, work performed, tools used and the start date on the project.
4
Sign and date
The employee signs and dates under the certification line. The second line, printed as INTERVIEW'S SIGNATURE, has its own date.
5
Add the interviewer's comments
Answer yes or no on classification and pay and on wage rates and poster, and note the work the employee was doing. The form says to use the reverse if more space is needed.
6
Complete the payroll check
The payroll checker marks whether the information agrees with payroll data, adds comments, and signs with name, title and date of check.

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What the form says

Where it goes

The form prints no address and no routing instructions.

Use of the information

The Privacy Act notice says any information furnished will be used only to verify the contractor's compliance with the Davis-Bacon Act, the Contract Work Hours and Safety Standards Act and the Copeland (anti-Kickback) Act.

Edition and authority

The footer reads GSA FORM 3017 (REV. 4-84). GSA's page gives a current revision date of 04/1984 and lists no authority or regulation.

Who fills out GSA Form 3017?

The employee interviewed
The Employee's Comments section asks about hours, overtime pay, fringe benefits, deductions, the work performed and the tools used. The employee signs under the line "I have read the above and certify it to be correct to best of my knowledge."
The interviewer
A second signature line with its own date sits beside the employee's, printed as INTERVIEW'S SIGNATURE. The Interviewer's Comments section follows it.
The payroll checker
The section For Use by Payroll Checker asks whether the information agrees with payroll data, with comments, a signature, name and title, and the date of check.
The contractor named at the top
The first blocks name the contract number, the prime contractor and the employer. The form does not ask the contractor to sign.

The form does not say who conducts the interview. Its sections and signature lines name these people.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA3017.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA3017

Who issues GSA Form 3017?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 3017 (REV. 4-84). Its Privacy Act notice says the collection is authorized by the U.S. Department of Labor, Standard Labor Provisions. GSA hosts the form in its forms library.

Is the employee required to answer?

The Privacy Act notice says the person is not required to supply the information, and that anything furnished will be used only to verify the contractor's compliance with the three laws it names.

What questions does the employee answer?

Whether they work over eight hours per day or forty hours per week, are paid at least time and a half for overtime hours, and receive fringe benefits required by the posted wage decisions, plus deductions, hours, work performed and tools used.

What does the payroll checker do on this form?

The payroll checker section asks whether the information is in agreement with payroll data, with comments and the checker's signature, name and title, and date of check.

Does GSA Form 3017 have instructions?

The PDF prints none, and it prints no OMB number. GSA's page gives a current revision date of 04/1984 and lists no authority or regulation.

GSA Form 3017: Labor Standards Interview