Various Economic Area Pretesting Activities

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

E-4

ANNUAL SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
MARCH 2012 – MUNICIPALITIES, COUNTIES, TOWNSHIPS
OMB No. 0607-0452: Approval Expires 04/30/2013

(11-09-10) 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

State

Zip Code

–
No
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.
PART 1 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

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.

Mark (X) ONE box only.
A

39 hours or more

C

34 to 37.4 hours

B

37.5 to 38.9 hours

D

32 to 33.9 hours

Continue on page 2

USCENSUSBUREAU

E

30 to 31.9 hours

19042019

§4%54¤

2

Page 2

FORM E-4 (11-09-10)

PART 2 – CONTRACTORS

3

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

➤

Go to 4 .

No – Go to 5 .

4

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

5 of this form.)

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 3 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS

5

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.
If some employees are on a different pay interval from the majority, please report these employees and their payroll
separately as indicated in the example below.
Report data by activity of individual units; not employee occupations. For example, a secretary in the streets and
highways department should be reported in “Streets and highways.” A person working in more than one of the
following categories should be reported only once-in the area of primary responsibility. If more than three pay
intervals need to be reported, please photocopy the necessary pages and return them with this form.
Include:
Do Not Report:
• Amounts withheld for taxes, employee
• Cumulative salaries since the beginning of the
contributions to retirement system, etc.
calendar or fiscal year.
Exclude:
• Payroll amounts from last fiscal year.
• Lump sum payments and the value of living quarters
• Employer costs of non-wage employee benefits such
and subsistence allowances furnished to employees.
as workers’ compensation, FICA, health insurance, etc.

Full-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Number of
Full-Time
Employees

TOTAL Sum of
totals 1 through 23 . . . . . . . . .

Example

Gross Payroll

Number of
Part-time
Employees

Hours
Paid

Gross Payroll

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

M

27

$

94500

.00

M

5

$

6000

.00

600

W

15

$

8250

.00

Q

2

$

10500

.00

300

Airport – Airport and air
terminal facilities owned
and operated by your
government. . . . . . . . . . . .

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

A. CENTRAL GOVERNMENT ADMINISTRATION
1. Financial
administration –
Treasurer’s office, auditor’s
or comptroller’s office, tax
assessing, tax billing and
collection, budgeting,
purchasing, central
accounting offices,
information technology,
and similar financial
administration. . . . . . . . . .

W = Weekly;

B = Bi-Weekly;

Payroll Frequency Codes
T = Twice a month; M = Monthly; Q = Quarterly;

Continue on page 3

S = Semi-Annually;

A = Annually

19042027

§4%5<¤

Part-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Page 3

FORM E-4 (11-09-10)

Full-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Number of
Full-Time
Employees

2. Central administration –
Council, board of
supervisors or
commissioners; central
administrative officers and
agencies, such as manager
or mayor; clerk; recorder;
zoning; central personnel
agency; and central
planning agency. Exclude
financial activities reported
in Financial administration
and judicial/legal activities
reported in Judicial and
legal. . . . . . . . . . . . . . . . . .
3. Judicial and legal – All
court and court related
activities, (except probation
activities reported in
Correction below), court
activities of sheriff’s office
(e.g., bailiffs, process
servers), prosecuting
attorney’s and public
defender’s offices, legal
department and attorneys
providing governmentwide legal services.
Exclude private attorneys
on retainer and court
appointed attorneys. . . . . .

Part-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Gross Payroll

Number of
Part-time
Employees

Hours
Paid

Gross Payroll

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

B. PUBLIC SAFETY
4. Police protection – Police department, law enforcement, activities of sheriff’s and constable’s offices, coroner, etc. Report school crossing guards as
part-time employees. Report sheriff’s correctional employees in Correction.

a. Persons with power
of arrest – Report
only police employees
here. Report other
employees with power
of arrest in Correction
or Judicial and legal.

b. Other police
protection
employees – All police
protection employees
not reported under
persons with power
of arrest . . . . . . . . . . . .

5. Correction – Jails,
reformatories, detention
homes, and probation and
parole activities for both
adults and juveniles.
Report lock-up employees
at Police protection.. . . .

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

§4%5D¤

a. Firefighters –

Persons engaged in
fire suppression and
prevention. Include
employees trained in
these activities but
performing such other
duties as dispatching,
emergency medical
care, etc. . . . . . . . . . . .

b. Other fire protection
employees –
All fire protection
employees not
included above. . . . . . .

W = Weekly;

B = Bi-Weekly;

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

Payroll Frequency Codes
T = Twice a month; M = Monthly; Q = Quarterly;

Continue on page 4

S = Semi-Annually;

A = Annually

19042035

6. Fire Protection – Report paid volunteer firefighters as part-time employees; exclude unpaid volunteers. Report forest fire protection employees in
Natural resources. Report separately identifiable rescue squad and emergency medical services in Health, if they are not a part of the fire department.

Page 4

FORM E-4 (11-09-10)

Full-Time Employees

C. TRANSPORTATION

Payroll
Frequency
Codes
Use
Codes at
Bottom

Number of
Full-Time
Employees

7. Streets and highways –
Maintenance, repair,
construction, and
administration of streets,
alleys, sidewalks, roads,
highways, and bridges.
Include engineering
ctivities and traffic signal
aintenance. Report street
cleaning employees in
Solid waste
management and sewer
employees in Sewers
and sewage disposal. . .

8. Airport – Airport and air
terminal facilities owned
and operated by your
government. . . . . . . . . . . .

9. Sea and inland port
facilities – Docks,
wharves, and related
warehouses owned and
operated by your
government. Report
facilities for pleasure
boats only in Parks
and recreation. . . . . . . . .

Part-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Gross Payroll

Number of
Part-time
Employees

Hours
Paid

Gross Payroll

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

D. SOCIAL SERVICES AND INCOME MAINTENANCE
10. Public welfare –
Maintenance of homes and
other institutions for the
needy, nursing homes,
administration of public
assistance and veteran
services, senior citizen and
handicap transportation,
social workers. Report
hospital employees under
Hospitals . . . . . . . . . . . . .
11. Health – Public health
services, emergency
medical services, mental
health, alcohol and drug
abuse, out-patient clinics,
visiting nurses, food and
sanitary inspections,
animal control, other
environmental health
activities (e.g., pollution
control), etc. . . . . . . . . . . .

12. Hospitals – Institutions
for in-patient medical care.
Include all paid student
help. Report nursing home
and welfare institution
employees in Public
welfare. . . . . . . . . . . . . . .

13. Solid waste
management –
Street cleaning, recycling,
garbage and refuse
collection and disposal,
operation of sanitary
landfill. . . . . . . . . . . . . . . .

14. Sewers and sewage
disposal – Provision,
maintenance, and
operation of sanitary and
storm sewer systems and
sewage disposal plants.
Report water supply
employees in Water
supply system. . . . . . . . .

W = Weekly;

B = Bi-Weekly;

Payroll Frequency Codes
T = Twice a month; M = Monthly; Q = Quarterly;
Continue on page 5

S = Semi-Annually;

A = Annually

19042043

§4%5L¤

E. ENVIRONMENT AND HOUSING

Page 5

FORM E-4 (11-09-10)

Full-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Number of
Full-Time
Employees

15. Parks and recreation –
Parks, playgrounds,
swimming pools,
auditoriums, museums,
marinas, zoos, etc. . . . . . .

16. Housing and community
development – Slum
clearance, redevelopment
programs, and any
housing projects of your
government. . . . . . . . . . . .

17. Natural resources –
Forest fire protection,
irrigation, drainage, flood
control, forestry,
agriculture, extension
service, etc. . . . . . . . . . . . .

Part-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Gross Payroll

Number of
Part-time
Employees

Hours
Paid

Gross Payroll

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

F. UTILITIES

18. Water supply system –
Public water supply
system operated by your
government. . . . . . . . . . . .

19. Electric power system –
Public electric power
supply or distribution
system operated by your
government. . . . . . . . . . . .

20. Gas supply system –
Public gas supply or
distribution system
operated by your
government. . . . . . . . . . . .

G. OTHER ACTIVITIES

22. Libraries – Public
libraries operated by your
government. Report law
libraries in Judicial and
legal. . . . . . . . . . . . . . . . .

W = Weekly;

B = Bi-Weekly;

Payroll Frequency Codes
T = Twice a month; M = Monthly; Q = Quarterly;

Continue on page 6

S = Semi-Annually;

A = Annually

19042050

§4%5S¤

21. Transit system – Public
transportation system
(bus, rail, etc.) operated
by your government.
Report transit system
exclusively for
handicapped or
senior citizens in
Public welfare. . . . . . . . .

Page 6

FORM E-4 (11-09-10)

Full-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Number of
Full-Time
Employees

23. All other – All employees
of your government and
its agencies not reported
elsewhere, except for any
school system employees,
and payrolls. Include
employees concerned with
elections and voter
registration, protective
inspection (building,
electrical, etc.), motor
pools, maintenance of
general public buildings,
parking facilities, and
other activities not
reported previously.
➤

TOTAL all other

Part-Time Employees
Payroll
Frequency
Codes
Use
Codes at
Bottom

Gross Payroll

Number of
Part-time
Employees

Hours
Paid

Gross Payroll

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

➤

List the major activities
reported above in
TOTAL all other

a.

b.

c.

d.

e.

f.

W = Weekly;

B = Bi-Weekly;

Payroll Frequency Codes
T = Twice a month; M = Monthly; Q = Quarterly;

S = Semi-Annually;

A = Annually

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)

/

/

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.

Please continue on page 10

19042068

§4%5e¤

PART 5 – ADDITIONAL REMARKS

Page 7

FORM E-4 (11-09-10)

DEFINITIONS
Please report figures covering all departments and agencies (except any school system employment and payrolls)
of the government named in the address label.
If your office records do not contain all the information
requested, please obtain the figures from other agencies for
inclusion in this report. If you cannot supply entirely comprehensive data, list in the remarks section at the end of this
questionnaire any agencies of your government that are not
included.
EMPLOYEES – Persons paid for personal services performed in the indicated pay period, including any persons in
a paid leave status. Include officials paid on a salary basis;
by fees or commissions; on a per meeting basis; or a flat
sum quarterly, semiannually, or annually. Employees who
have multiple responsibilities should be reported only once
at the functional classification which is their primary responsibility. For example, employees in city or county clerk offices
may have financial administration, central administration,
and judicial responsibility; these employees and their total
gross pay should be reported only at the one activity which
accounts for most of their time. Exclude school system
employees, 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 full-time 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 part-time paid officials.
Exclude here, and report as full-time, any temporary or
seasonal employees working on a full-time basis during the
pay period.
EMPLOYEES IN FEDERALLY FUNDED PROGRAMS –
Persons paid from Federal grant funds should be reported
as employees of this government. Report these employees
and their pay in the appropriate functional classification.

PAYROLL (GROSS BEFORE DEDUCTIONS) – Salaries,
wages, fees, or commissions earned during (applicable to)
the pay period(s) which includes March 12, 2012. Include
overtime, premium, and night differential pay. Include
bonus 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 pay interval for all persons working less than the
number of hours that represents full-time employment.
Include an estimate of hours worked during pay interval for
part-time employees and officials not compensated on an
hourly basis.
SHERIFF’S OFFICE EMPLOYEES – In addition to reporting
employees and payrolls in “Police protection,” court bailiffs
and any other court employees should be reported in
“Judicial and legal.” Any sheriff’s office employees engaged
in probation/parole activities or the operation of jails or other
detention facilities (except “lock-ups” holding persons for
less than 48 hours) should be reported in “Correction”.
FEE OFFICES – Include employees of fee offices in
“Financial administration.” If information on fee office
employees and payrolls is not available, please note and list
the fee offices in “Additional Remarks”.
EDUCATION EMPLOYEES – Exclude any school system
employees and payrolls from this form. Include any county
supervision of public school districts in “All other.”
ELECTED OFFICIALS – Include all elected or appointed
officials who receive any amount on this form. Per-meeting
or annual pay should be reported (even small amounts such
as $25 per meeting or $100 annually). Council, board members, mayor, clerk, trustee, etc. should be reported at “Central
Administration.” Treasurer, assessor, or financial officials
should be reported at “Financial Administration.”

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

6. If exact figures are not available, enter estimates and mark with an asterisk.
7. Complete the "Certification" box on page 6 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 6.
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 15 minutes to 15 hours per response, with an average of 1.5 hour per response for this form type (E-4), 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.

19042076

§4%5S¤

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.