If the answer to question 3(a) is “Yes,” complete 3(b) and (c). If the answer to 3(a) is “No,” go to 3(d).

If 3(d) is answered “Yes,” complete 3(e), if applicable, and show the following information in 3(f):

• •

  rate of pay

• •

  amount (e.g., 35 hours) worked per pay period

• •

  how often paid

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  pay day (e.g., “paid every Friday” or “paid on 1st and 15th of each month”)

• •

  date last paid

If the individual expects any change in wages (question 3(g)), explain in (h).

If questions 3(a) and (d) are both answered “No,” go to question 4.