Various Economic Area Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

E-3

ANNUAL SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
MARCH 2012 – SPECIAL DISTRICTS AND LOCAL AGENCIES
OMB No. 0607-0452: Approval Expires 04/30/2013

(11-09-2010) Draft 4

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001
If you have any questions,
please call 1-800-642-4901
Weekdays, 7am to 5pm EST.
Questions may also be emailed
to: [email protected]

In correspondence
pertaining to this report,
please refer to the User ID
below the address box.

INTERNET RESPONSE: If you prefer, you may respond
to this survey via the Internet at the following web
address: http://harvester.census.gov/sgenet
You will need your User ID to access the Internet form.

1

User ID
➤

Has your address changed from what is shown in the address label?
Yes, the new address is:
Contact Title

Street

City

Zip Code

State

No, Go to

2

.

For the remainder of the survey, employees are defined as persons paid for personal services performed in the
indicated pay period, including persons in a paid leave status.
Include:
• Any officials paid on a salary basis; by fees or commissions; on a per meeting basis; or a flat sum quarterly,
semiannually, or annually.
Exclude:
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees.

2

Please complete this survey form if your agency currently has paid employees/officials.
If your agency has NO PAID employees/officials, mark (x) here
Continue on page 2

USCENSUSBUREAU

➤

Go to

3

.

19032010

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–

Page 2

FORM E-3 (11-09-10)

PART 1 – CONTRACTORS

3

Does your government have employees who are contractors during the month of March 2012?
Yes – Total number of contractor’s

➤

No – If you have paid employees, Go to

Go to
5

.

No – If you have no contractors and no paid employees, Go to
4

.

4

7

.

If yes, please answer the following questions. (Please do not include data on contractors in
of this form.)

6

a. During March 2012, how many non-governmental contractors
(private sector) does your government employ? . . . . . . . . . . . . . . . . . . . . .
b. Please provide the payroll amount for the month of
March 2012 for the non-governmental contractors listed
in a. If unable to provide a payroll amount, please explain in
Part 5 (Additional Remarks) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

c. During March 2012, how many government contractors
(employees from other governments) does your government
employ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Please provide the payroll amount for the month of
March 2012 for governmental contractors listed in c.
If unable to provide a payroll amount, please explain in
Part 5 (Additional Remarks) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

.00

PART 2 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

5

On average, how many hours per week do the majority of your full-time employees
(non-contracted) work?
Full-time employees are persons employed during the pay period to work the number of hours per
week that represents regular full-time employment.
Include:
• Temporary or seasonal employees who are working the number of hours that represent full-time employment.
• Any officials paid on a salary basis; by fees or commissions; on a per meeting basis; or a flat sum quarterly,
semiannually, or annually.
Exclude:
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees.

A

39 hours or more

C

34 to 37.4 hours

E

30 to 31.9 hours

B

37.5 to 38.9 hours

D

32 to 33.9 hours

F

None

Continue on page 3

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Mark (X) ONE box only.

Page 3

FORM E-3 (11-09-10)

PART 3 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS

6

For each different pay interval, what were the TOTAL number of employees and TOTAL gross
payroll amounts for the pay period which includes MARCH 12, 2012 for both full-time and
part-time employees? Please also report hours paid for each applicable pay interval for
part-time employees.
Payroll (Gross Before Deductions) includes salaries, wages, fees, or commissions earned by employees during
(or applicable to) the pay period(s) which includes March 12, 2012.
Part-time hours paid are the total hours actually paid during the pay interval for all persons working less than
the number of hours that represents full-time employment.
Include:
• Amounts withheld for taxes, employee contributions to retirement systems, etc.
• An estimate of hours worked during the pay interval for part-time employees, not compensation on an
hourly basis.
Exclude:
• Lump sum payments and the value of living quarters and subsistence allowances furnished to employees.
Report:
Cumulative salaries since the beginning of the calendar or fiscal year.
Payroll amounts from last fiscal year.
Employer costs of non-wage employee benefits such as workers’ compensation, FICA, health insurance, etc.

Full-Time Employees
Number of
Full-Time
Employees

(Examples)
Monthly . . . . . . . . .

Weekly . . . . . . . . . .

Annually . . . . . . . . .

Weekly . . . . . . . . . . . . . . . .
Bi-Weekly . . . . . . . . . . . . . .
Twice a Month . . . . . . . . . .

§4$5E¤

Monthly . . . . . . . . . . . . . . .
Quarterly. . . . . . . . . . . . . . .
Semi-Annually . . . . . . . . . .
Annually . . . . . . . . . . . . . . .

Part-Time Employees
Number of
Part-Time
Employees

Gross Payroll

27

$

94500

.00

15

$

8250

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

........

5

........
........
........
........
........
........
........
........

Continue on page 4

$

6000

$

........

2

Hours
Paid

Gross Payroll

$

.00

600

.00

21000

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

625

19032036

Do Not
•
•
•

Page 4

FORM E-3 (11-09-10)

PART 4 – CERTIFICATION

7

This report is substantially accurate and has been prepared in accordance with the instructions.
Name of person completing this report

Title of person completing report

Telephone

Extension

Fax

Email

Date form was completed (MM/DD/YYYY)

/

/

PART 5 – ADDITIONAL REMARKS

8

Were there any groups of your employees for which you could not supply information or any
difficulties you encountered in completing the form? If yes, please provide an explanation for
any significant changes to employment or payroll occurring within the last year that would
aid in understanding this report.

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Please continue on page 10

Page 5

FORM E-3 (11-09-10)

DEFINITIONS
EMPLOYEES – Persons paid for personal services performed in the indicated pay period, including persons in
a paid leave status. Include any officials paid on a salary
basis; by fees or commissions; on a per meeting basis;
or a flat sum quarterly, semiannually, or annually.
Exclude employees on unpaid leave, unpaid officials,
pensioners, and contractors and their employees.
FULL-TIME EMPLOYEES – Persons employed during
the pay period to work the number of hours per week that
represents regular full-time employment. Include temporary or seasonal employees who are working the
number of hours that represents full-time employment.
PART-TIME EMPLOYEES – Persons employed on a partbasis during the designated pay period. Include those
daily or hourly employees usually engaged for less than
the regular full-time workweek, as well as any partpaid
officials. Exclude here, and report as full-time, any temporary or seasonal employees working on a full-time
basis during this pay period.

PAYROLL (GROSS BEFORE DEDUCTIONS) – Salaries,
wages, fees, or commissions earned by employees during
(or applicable to) the pay period(s) which includes March
12, 2012. Include overtime, premium, night differential
pay, bonuses, and incentive payments that are paid at
regular pay intervals. Include amounts withheld for
taxes, employee contributions to retirement systems, etc.
Exclude employer share of fringe benefits, lump sum
payments and the value of living quarters and subsistence
allowances furnished to employees.
If some employees are on a different pay interval
from the majority, please report these employees, their
payroll, and part-time hours separately.
PART-TIME HOURS PAID – Total hours actually paid
during the pay interval for all persons working less than
the number of hours that represents full-time employment. Include an estimate of hours worked during the
pay interval for part-time employees not compensated on
an hourly basis.

GENERAL INSTRUCTIONS
1.

Indicate in Part 2 the standard weekly hours of work for most full-time employees.

2.

Include all current employees whether paid from the general fund or special funds.

3.

Report in Part 3 gross payroll amounts for just the ONE PAY PERIOD which includes March 12, 2012.
a. Do not report cumulative salaries since the beginning of the calendar or fiscal year.
b. Do not report payroll amounts from last fiscal year.

4.

Include total paid hours of work for part-time employees in Part 3, last column. If actual hours are not
known, please enter an estimate.

5.

If you are unable to supply any of the information requested in Part 3, please list in “Additional remarks”
the source(s) of the missing information (including address and telephone number). Please provide an
explanation for any significant changes to employment or payroll occurring within the last year that would
aid in understanding this report.

6.

If exact figures are not available, enter estimates and mark with an asterisk.

7.

Complete the "Certification" box on page 4 of the form and return the completed questionnaire in the
envelope provided. If additional people assisted in completing this report, please include contact information
in "Additional remarks" on page 4.

8.

Retain a copy of the completed questionnaire for your records.

Thank you.

NOTE: Please note that this is a national form that applies to governments with wide differences in the size of their service areas, the
amount of the population served, and the extent and complexity of their activities. Public reporting burden for this collection of information
is estimated to vary from 10 minutes to 1 ½ hours per response, with an average of 20 minutes per response for this form type (E-3),
including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information
unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0452, U.S. Census Bureau, 4600 Silver
Hill Road, AMSD – 3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use Paperwork Project 0607-0452
as the subject.

19032051

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c. Do not report the employer costs of non-wage employee benefits such as workers’ compensation,
FICA, health insurance, etc.