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Sheet 1: Front

OCCUPATIONAL EMPLOYMENT REPORT

In Cooperation with the

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U.S. Department of Labor

Form Approved O.M.B. No. 1220-0042

What this report is about: This form asks for information about the occupations and wage ranges of the employees described in Item 2 below. Please complete Items 1 through 5 on this page. Next, please provide the information requested beginning on page 1 for the employees who worked during or received pay for the pay period that included the reference date in Item 2, printed directly above your establishment name. The instructions on pages ii and 1 explain how to provide the information. Please see our website at http://www.bls.gov/OES for more information on the OES Program, including a display of national, state and metropolitan area employment and wage estimates by occupation.

1

Which of the following options describes the status of the location(s) in Item 2 as of the reference date also printed in Item 2?

Operating: Go to item 2.

Temporarily closed during the reference period: Report data only for employees paid for work during the reference period. If no employees worked for pay, report "0" in section 4 of this page and return the form in the reply envelope provided.

Permanently out of business as of __/__/____:

Return the form to the address at the top.

New Name: _____________________________________

Sold or merged: Enter the new name and address

New Address: _____________________________________

in the box to the right, then go to item 2.

_____________________________________

2

This form asks for information about the employees described in the box to the right. Our estimate of employment for these employees appears at the top right corner of the label. Please make any needed address corrections below.

_________________________________________

_________________________________________

_________________________________________

3

Our records show that your main products or services are related to those listed in the box to the right. If they are not, please list your main products or services on the lines below and continue with the rest of the report.

_________________________________________

_________________________________________

_________________________________________

4

How many employees, both full and part-time, worked at this location(s) during the pay period that included the reference date printed in Item 2?

Include

Do Not Include

w Full or part-time paid workers

w Contractors and temporary agency

w Workers on paid leave

employees not on your payroll

Enter the number here:

w Workers assigned temporarily

w Unpaid family workers

to other units

w Workers on unpaid leave

Do all employees reported above work at one

w Incorporated firms - paid owners,

w Unincorporated firms - proprietors,

location?

officers, and staff

owners, and partners

Yes

w Workers not covered by

No…Enter number of locations:

unemployment insurance

5

Please tell us who to contact if we have questions about your data.

Name: _____________________________________________

FOR OFFICE USE ONLY

Title: ______________________________________________

Phone: (_____)______-______Ext._____ Date: _____________

E-mail address: _____________________________________

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Sheet 2: Interior_portrait

Instructions for Reporting by Occupation

h Report employees in the occupations in which they are working, not in occupations for which they have been trained.

For example: An employee trained as an engineer, but working as a drafter, should be reported as a drafter.

h Report each employee only once in the occupation that requires the highest level of skill if the employee

performs work in two or more occupations. If there is no measurable difference in skill requirements, report

employees in the occupation in which they spend the most time.

h Use the description of duties along with the job titles to determine where to place employees.

Do not rely on job titles alone.

h Report apprentices and trainees in the job for which they are being trained. Report helpers separately because

they are not in training for the occupation they are helping.

h Report part-time workers in the job they perform.

h Professionals who directly supervise other workers in professional occupations should be classified in the same

occupation as the workers they supervise. For example, a drafter that supervises other drafters is classified as a drafter.

h Workers in Service, Sales, Office and Administrative, Forestry and Farming, Production, Maintenance, and

Transportation occupations who spend 80 percent or more of their time performing supervisory duties should be

reported as supervisors. Workers with supervisory duties who spend less than 80 percent of their time supervising

should be reported with the workers they supervise.

Instructions for Reporting Wage Information

For all employees:

h Please use the hourly and annual wage rate categories to report employees. If wages are not recorded

by hour or year (bi-weekly, or monthly for example), convert them into an hourly wage rate.

h For part-time workers, please report the specific hourly wage rate, not an average.

h For tip, commission, and piece-rate workers, please estimate the earnings (base pay plus tips,

commissions, or piece rates), and report the appropriate wage.

h For salaried workers who do not work a standard 2080 hours per year (40 hours per week), please report

wages on an hourly basis. For workers who are paid an annual salary by contract, such as Airline Pilots,

report their annual salary.

h Include and/or exclude from pay as follows:

Include as pay:

Exclude as pay:

h Base Rate

h Attendance Bonus

h Overtime Pay

h Commissions

h Back Pay

h Perquisites

h Tips

h Draw

h Severance Pay

h Deadheading Pay

h Holiday Premium Pay

h Shift Differential

h Guaranteed Pay

h Jury Duty Pay

h Stock Bonuses

h Hazard Pay

h Lodging Payments

h Tool Allowance

h Incentive Pay

h Meal Payments

h Vacation Pay

h Longevity Pay

h Merchandise Discounts

h Weekend Pay

h Piece Rate

h Profit Sharing Payment

h Uniform Allowance

h Portal-to-Portal Rate

h Relocation Allowance

h On-call Pay

h Production Bonus

h Tuition Repayments

h Nonproduction Bonus

h Cost-of-Living Allowance

(e.g., Holiday Bonus)

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. This report is authorized by law, 29 U.S.C. §2. Your voluntary cooperation is needed to make the results of this report comprehensive, accurate, and timely.

*We estimate that it will vary from 30 minutes to 6 hours to complete this report, depending on such factors as the size of the establishment. This includes time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding these estimates or any other aspects of this report, including suggestions for reducing this burden, send them to the U.S. Bureau of Labor Statistics, Division of Occupational Employment Statistics (1220-0042), 2 Massachusetts Avenue NE, Suite 2135, Washington, DC 20212. Please do not return your questionnaire to this address. Use the enclosed preaddressed envelope or the address provided at the top of the first page to return your completed questionnaire. You do not have to complete this questionnaire if it does not display a currently valid OMB control number.

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Sheet 3: Body

6

If returning via facsimile, enter the 10 digit Schedule Number (found at the top of the address label on page i):

__ __ __ __ __ __ __ __ __ - __

7

Please use the following pages to report the employees found in your firm. Please write in each unique employee by occupation title. If there are multiple employees with the same occupational title, please list them seperately. Include a short description of duties, their wage, and their wage interval (Annual, Bi-weekly, Hourly, or Other). If Other, please provide a brief explanation. Also indicate if this wage includes tips, as well as the the number of hours the employee worked during the reference week. Refer to page ii for detailed instructions on how to report by occupation and how to determine wages. If additional space is needed to report all of the workers in your establishment, please photocopy this page.

OCCUPATIONAL TITLE AND DESCRIPTION OF DUTIES

Report Part-time Workers According to an Hourly Rate

WAGE OR SALARY

WAGE RATE FREQUENCY

EXPLANATION (If "Other")

HOURS WORKED

TIPS INCLUDED (Yes or No)

EXAMPLE:

Secretaries - Performs administrative duties, typing, and other tasks as needed.

$12.50

O Annual O Bi-weekly O Hourly O Other

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O Yes

O Bi-weekly

 Hourly

 No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

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Sheet 4: Last

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If returning via facsimile, enter the 10 digit Schedule Number (found at the top of the address label on page i):

__ __ __ __ __ __ __ __ __ - __

OCCUPATIONAL TITLE AND DESCRIPTION OF DUTIES

Report Part-time Workers According to an Hourly Rate

WAGE OR SALARY

WAGE RATE FREQUENCY

EXPLANATION (If "Other")

HOURS WORKED

TIPS INCLUDED (Yes or No)

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

O Annual

O Yes

O Bi-weekly

O Hourly

O No

O Other

FOR OFFICE USE ONLY

FIPS Code

Schedule Number

Total Employment

Reviewed By

Date Reviewed

Total Employment

T

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Sheet 5: standard 3

6

If returning via facsimile, enter the 10 digit Schedule Number (found at the top of the address label on page i):

__ __ __ __ __ __ __ __ __ - __

7

Please use the following pages to report the employees found in your firm. Please write in each unique occupational title, a short description of duties, the number of employees found in each wage column, and the total employment for each occupation. Refer to page ii for detailed instructions on how to report by occupation and how to determine wages. If additional space is needed to report all of the workers in your establishment, please photocopy this page.

OCCUPATIONAL TITLE AND DESCRIPTION OF DUTIES

NUMBER OF EMPLOYEES IN SELECTED WAGE RANGES

(Report Part-time Workers According to an Hourly Rate)

A

B

C

D

E

F

G

H

I

J

K

L

T

Hourly part-time or full-time)

under $9.25

$9.25 - 11.49

$11.50 - 14.49

$14.50 - 18.24

$18.25 - 22.74

$22.75 - 28.74

$28.75 - 35.99

$36.00 - 45.24

$45.25 - 56.99

$57.00 - 71.49

$71.50 - 89.99

$90.00 and over

Total Employment

Annual Salary (full-time only)

under $19,240

$19,240 - 23,919

$23,920 - 30,159

$30,160 - 37,959

$37,960 - 47,319

$47,320 - 59,799

$59,800 - 74,879

$74,880 - 94,119

$94,120 - 118,559

$118,560 - 148,719

$148,720 - 187,199

$187,200 and over

EXAMPLE:

Secretaries -

A

B

C

D

E

F

G

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Performs administrative duties, typing, and other tasks as needed.

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1

3

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Sheet 6: standard 4

8

If returning via facsimile, enter the 10 digit Schedule Number (found at the top of the address label on page i):

__ __ __ __ __ __ __ __ __ - __

OCCUPATIONAL TITLE AND DESCRIPTION OF DUTIES

NUMBER OF EMPLOYEES IN SELECTED WAGE RANGES

(Report Part-time Workers According to an Hourly Rate)

A

B

C

D

E

F

G

H

I

J

K

L

T

Hourly part-time or full-time)

under $9.25

$9.25 - 11.49

$11.50 - 14.49

$14.50 - 18.24

$18.25 - 22.74

$22.75 - 28.74

$28.75 - 35.99

$36.00 - 45.24

$45.25 - 56.99

$57.00 - 71.49

$71.50 - 89.99

$90.00 and over

Total Employment

Annual Salary (full-time only)

under $19,240

$19,240 - 23,919

$23,920 - 30,159

$30,160 - 37,959

$37,960 - 47,319

$47,320 - 59,799

$59,800 - 74,879

$74,880 - 94,119

$94,120 - 118,559

$118,560 - 148,719

$148,720 - 187,199

$187,200 and over

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FOR OFFICE USE ONLY

FIPS Code

Schedule Number

NAICS Code

Unit Total Employment

Reviewed By

Date Reviewed

Total Employment

T