Private Sector Fax Report Form-Revised

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Bureau of Labor Statistics: Report on Current Employment Statistics
U.S. Department of Labor


This report is authorized by law 29 U.S.C. 2.  We request your cooperation to make the results of this survey comprehensive, accurate, and timely. The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law.  In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent.  Please note this report is mandatory in North Carolina, under Section 96-4(g) (l) of the North Carolina Employment Security Law; in Oregon, under the Oregon Revised Statute 657.660; in Washington, under the Revised Code of Washington sections 50.12.010, 50.12.070, and 50.12.180; and in South Carolina, under Section 41-29-120 of the Code of Laws of South Carolina (for firms employing more than twenty individuals).  Form Approved OMB No.  1220-0011.   We estimate that it will take an average of 11 minutes to complete this form each month including time to review instructions, search existing data sources, gather and maintain the necessary data, and complete and review this information.  If you have any comments regarding these estimates or any other aspects of this survey, send them to the Bureau of Labor Statistics, Division of Current Employment Statistics (1220-0011), 2 Massachusetts Avenue, NE, Washington, DC 20212.  You are not required to respond to the collection of information unless it displays a currently valid OMB control number.

Dear Payroll Manager:

Thank you for providing your employment, payroll, and hours data to the Current Employment Statistics program.  Enclosed is your FAX Report Form.  Please fill out the form only for the pay period which includes the 12th of the month and fax it to the telephone number provided below by duedate2.

For each worksite with a pre-printed CES report number and worksite description, report all columns for All Workers and Production, Construction or Nonsupervisory Workers separately.  If a worksite has more than one pay frequency, please call the information number for more information.  Detailed definitions and instructions are provided below.

Your response to this report is kept confidential and is used to generate monthly estimates of employment levels and changes, average hourly earnings, and average weekly hours.  It also contributes to other statistics including state and local unemployment rates, productivity measures, and the gross domestic product (GDP).  Be sure to watch for the release of the national employment situation report on the first Friday of each month.  Your data are included in this important release.

If any of the information pre-printed on this form is incorrect or if you have any questions, please contact us at dccphone2.

FAX Report to:   faxphone2




Fax your report form to:
faxphone

Con_Firm

 Not later than:
duedate

Con_Address




Con_City, Con_State   Con_Zipcode

Address:
Data Collection Center




dccaddress




dcccity, dccst   dcczip



Any questions? Please call:
dccphone

Contact person, in case of questions:
Title:
Phone Number:
Fax Number:
     
title
phone 
fax

Instructions for Completing this Form
Reference MONTH and YEAR
	Enter the reference Month and Year of the report.  Complete this form monthly for the pay period that includes the 12th day of the reference Month and Year.  If you have a weekly or biweekly pay period and the 12th falls on a Saturday, report for the period ending on the 12th. If the 12th falls on a Sunday, report for the pay period starting on the 12th.
PAY GROUP
    • Same pay schedule for all employees?  Enter the information requested in Pay Group 1.
	Different pay schedules for some employees—for example, weekly pay for some and monthly for others?  Enter the information for one group in Pay Group 1 and for the second in Pay Group 2.
If your business has more than two pay groups, call the help number shown above for assistance.











EMPLOYEE COUNT (Column 1) – ALL WORKERS
	Total number of persons in this pay group who worked or received pay for any part of the pay period that includes the 12th of the month.
Include:
Exclude:
	Executives and their staff
	Outside contractors and their employees
	Full-time and part-time workers
	Pensioners
	Salaried officials of corporations
	Proprietors, owners, or partners of
	Trainees
	unincorporated firms
	Workers on active duty, if 
	Workers on active duty, if not receiving  
	receiving pay from employer
	pay from employer
	Workers on paid sick leave
	Workers on leave without pay for entire
	Workers on paid vacation
	pay period
	Workers on other paid leave
	Workers on strike for entire pay period

	Unpaid family members
EMPLOYEE COUNT (Column 1) – PRODUCTION, CONSTRUCTION, OR Nonsupervisory workers
	Number of "All Workers" defined above who are production, construction, or nonsupervisory workers.  See the definition for each type of employees below:
A.  production workers – 	In the Manufacturing and Natural Resources and Mining Industries, “Production Workers” include working supervisors or group leaders who may be “in charge” of some employees, but whose supervisory functions are only incidental to their regular work. 
Instructions for Completing this Form (Continued)
			In the Manufacturing Industry:
Include individuals working in:
Exclude individuals working in:
    • Assembling
    • Fabricating
    • Janitorial activities
    • Maintenance or repair
    • Materials handling
    • Processing
    • Product development
    • Recordkeeping related to production
    • Shipping or receiving
    • Storage or warehousing
    • Trucking

    • Accounting or finance
    • Advertising
    • Cafeterias
    • Collection and credit
    • Executive, professional, or technical positions
    • Force account construction
    • Legal
    • Medical
    • Personnel
    • Product installation or servicing
    • Purchasing
    • Recordkeeping not related to production
    • Sales and delivery
				In the Natural Resources and Mining Industry:
Mining, quarrying, crude petroleum production, and natural gas production include individuals working in:
 Blasting
 Drilling
 Hauling
 Maintenance
 Cleaning
 Excavating
 Hoisting
 Processing
 Crushing
 Flow control
 Inspection
 Pumping
 Development
 Guard service
 Janitorial
 Repair
 Drainage
 Handling
 Loading

 Shipping
 Storage
 Trucking

 Warehousing
 Ventilation
 Rig building

Logging industries
 Cutting timber
Transporting timber
 Producing wood chips in the field
Exclude individuals working in:
 Accounting or finance
 Advertising
 Executive, professional, and technical positions
 Personnel
 Purchasing
 Cafeterias
 Legal
    •  Sales
 Collection and credit
 Medical

B.  construction workers – Construction workers include working supervisors or group leaders who may be “in charge” of some employees, but whose supervisory functions are only incidental to their regular work.  Construction workers work at the site of construction, or in shops or yards at jobs ordinarily performed by members of the construction trade. 
Include:
Working in:
	Craft workers
	New construction
	Laborers
	Alterations
	Mechanics
	Remodeling
	Heavy equipment operators
	Demolition
	Apprentices
	Maintenance
	Helpers
	Repair
				Exclude individuals working in:
	Accounting
	Personnel
	Clerical
	Professional
	Executives
	Purchasing
	Finance
	Technical
	Legal

C.  Nonsupervisory workers –	"Nonsupervisory workers" includes every employee except those whose major responsibility is to supervise, plan, or direct the work of others.  
Exclude:

	Department heads

	Executives

	Managers

	Officers

	Superintendents


WOMEN EMPLOYEE COUNT (Column 2)            (Continued)
Number of employees from Column 1 who are women.







Payroll, EXCLUDING COMMISSIONS (Column 3)
	Total gross pay earned during the entire pay period.  Report separately for All Workers and for Nonsupervisory Workers.  
Report pay before employee deductions for:

	Taxes
	Bonds

	FICA (Social Security)
	Pensions 

	Health insurance
	Unemployment insurance

	Pay deferral plans such as 401K 
	Union dues




Include:
Exclude:
	Wages and salaries
	Commissions
	Paid holidays, vacation, sick 	leave, and other paid leave
    • Incentive pay
	Annual pay for unused leave
	Awards or bonuses not paid each pay period
	Bonuses paid each pay period
    • Overtime pay
    • Tips if included on W-2s
	Employer contributions to pay such as 401K
	Severance, if paid over multiple pay periods

	Pay advances, such as vacation pay advances
    • Payments "in kind"

	Retroactive or back pay

	Severance, if provided as one payment

	Travel or work-related reimbursements
Length of Pay: regular pay (Column 4)
A 1-digit code that describes the length of the payroll period reported in column 2.  Enter '1' for Weekly payroll, '2' for Bi-Weekly payroll, '3' for Semi-Monthly payroll or '4' for Monthly payroll.  
Commissions (Column 5)
	Report separately for All Workers and Production, Construction, or Nonsupervisory Workers.
		Report for the most recent complete period for which commissions are available, which might be different from the pay period that includes the 12th.  Enter 0 if none paid for the period or pay group.
    • Exclude base pay, drawing accounts, or basic guarantees.
Length of Pay: commissions (Column 6)
A 1-digit code that describes the length of the length of pay for commissions reported in column 4.  Enter '1' for Weekly payroll, '2' for Bi-Weekly payroll, '3' for Semi-Monthly payroll or '4' for Monthly payroll.  If commissions are not reported, leave this column blank.
Hours, INCLUDING OVERTIME (Column 7) 
	Total number of hours for which employees received pay during the entire pay period.  Report separately for All Workers and Production, Construction or Nonsupervisory Workers.
	Include overtime; stand-by or reporting time; and hours not worked, but for which workers received pay (holidays, vacations, sick leave, etc.).  
	Report hours for salaried and commission-only employees based on their standard work week. 	
    • Do not convert overtime or other premium hours to straight-time equivalent hours. 
Overtime Hours (Column 8) 
Total number of hours for which employees received overtime premiums because they worked more than their regularly scheduled hours.  Report separately for All Workers and Production Workers.  Report Overtime 
Hours only for worksites in the Manufacturing Industry.
    • Include Saturday, Sunday, 6th day, 7th day, and holiday hours.
    • Exclude shift differential, hazard, incentive, or similar premiums. 
Gross Monthly Earnings (Column 9)
Total gross wages paid during the entire previous calendar month, before deductions.  Report for All Workers only.
Include:
Exclude:
	Earnings from all pay distributed:
	Employer contributions to:
	-	Payroll
	-	Medical insurance accounts
	-	Commissions
	-	Health insurance accounts
	-	Bonuses or awards
	Reimbursements for:
	-	Incentive pay
	-	Travel expenses
	-	Severance pay
	-	Work related expenses
	-	Stock options exercised 
	-	Tuition 

Bureau of Labor Statistics: Report on Current Employment Statistics – FAX Report Form
U.S. Department of Labor

Firm Name: Con_Firm1
Contact:  
Title: title1
Form Approved
O.M.B. No. 1220-0011
Telephone: phone1
Fax Phone: fax1
Please fax report to: faxphone3
by
duedate3

Enter in columns 4 and 6 one of the following codes for the length of pay: 
1 Each week
2 Every two weeks
3 Twice a month
4 Once a month
IMPORTANT:  Report columns 1-8 for the pay period that includes the 12th of the month.  Report column 9 for the entire previous month.



Payroll
Hours


1
2
3
4
5
6
7
8
9
Reference Month/Year: 
Refmonyr

Employee Count


Women
Employee
Count


Payroll, Excluding Commissions



(Whole dollars)
Length of  Pay: Regular Pay
Commissions





(Whole dollars)
Length of Pay: Commissions
Total Hours, including overtime



(Whole hours)
Overtime Hours
(Manufacturing only)


(Whole hours)
Gross Monthly Earnings, previous calendar month


(Whole dollars)
Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX

Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX

Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX
	
Production, Construction, or Nonsupervisory Workers







XXXXX

Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX


Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX

Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX

Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX


Report #: reptnum
State:  STC 
Location: REGlocation
All Workers







XXXXX

Production, Construction, or Nonsupervisory Workers







XXXXX

If the pre-printed information on this form is incorrect, or you need help filling out this form, please contact us at dccphone3.                 pc#