Round 1 Cognitive Testing of E-6 Changes

ASPEP E6 Testing F&R_Final.pdf

Public Employment & Payroll Forms

Round 1 Cognitive Testing of E-6 Changes

OMB: 0607-0452

Document [pdf]
Download: pdf | pdf
Prepared for:
Erika Becker Medina (GOVS)
Larry Long (GOVS)

Prepared by:
Jennifer Beck

Office of Economic Planning & Innovation
Economic Programs Directorate
U.S. Census Bureau

October 5, 2012

Table of Contents
Background .................................................................................................................................................................3
Research Methodology ..............................................................................................................................................3
Participants .........................................................................................................................................................3
Materials .............................................................................................................................................................4
Procedures..........................................................................................................................................................4
E-4 Findings and Recommendations ..........................................................................................................................4
Finding #1: Overall impressions of the forms.....................................................................................................4
Finding #2: Form splitting –E-8 and E-10............................................................................................................5
Finding #3: Multiple Pay intervals ......................................................................................................................5
Finding #4: Misclassification errors ....................................................................................................................6
Finding #5: Online Reporting ..............................................................................................................................7
Item-specific Findings and Recommendations...........................................................................................................7
Finding #6: Item 2 – Full-time hours...................................................................................................................7
Finding #7: Part 2 instructions and example ......................................................................................................8
Finding #8: Part 2 section headers .....................................................................................................................8
Appendix A: Cognitive Interview Protocol .............................................................................................................. 10
Appendix B: Questionnaires Used During Cognitive Testing................................................................................... 12

ASPEP E-6 Split Testing
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Background
Response Improvement Research Staff (RIRS) conduct additional pretesting for the Governments Division’s
(GOVS) Annual Survey of Public Employees and Payroll (ASPEP) E-6 form. The ASPEP collects information about
the amount of payroll and the frequency of pay for employees across a variety of government entities, including
schools, universities, special districts, towns, and municipalities. The current testing is the final round of testing
for the newly redesigned forms for the 2013 data collection year.
In March and June of 2012, RIRS conducted two rounds of cognitive pretesting on the redesigned forms. The
paper forms have migrated into the Census Bureau’s integrated Computer-Assisted Data Entry (iCADE) data
capture system and will make use of the Optical Character Recognition processing capability of that system. The
first two rounds of testing evaluated the new layout. The iCADE processing requirements changed the layout,
resulting in an increase the number of pages of the forms. Respondents in these two rounds noticed and did not
like this change. Their initial perceptions of this change were that the form was more burdensome and asking for
new information, making it less likely that respondents would report in a timely manner.
Based on this feedback, the ASPEP staff looked into ways to reduce the number of pages on the redesigned
forms to help the forma appear less burdensome. For the E-6 form, which applies to all types of school systems,
the ASPEP staff looked into tailoring the form to specific types of schools. The current E-6 form applies to three
different types of schools: Elementary and Secondary educational programs, Post-secondary educational
programs, and schools that offer both kinds of educational programs. Respondents at schools that offer only
one type of educational programs have had to locate and fill out only the appropriate sections of the form,
leaving the sections of the form that do not apply blank. Not only does having this single form foster response
errors when respondents fail to fill out the correct section of the form, it also increases the perceived length on
the form.
Based on these problems, we recommended splitting the E-6 into three separate component forms: new form
that would go to Elementary and Secondary schools (Form E-8), a new form that would go to the Post-secondary
schools (Form E-10), containing only the relevant sections of the form, and the current E-6 that would remain
the same but only go to those schools that offer both types of educational programs. We tested the division of
this form into the three components for this round of testing.

Research Methodology
Participants
In September, 2012, we conducted 10 interviews with respondents from schools in the Philadelphia,
Pennsylvania metropolitan area. While we attempted to recruit all three types of school systems, we focused
our efforts on schools with both types of educational programs, and schools that offered Post-secondary
programs. In previous rounds of testing, we were unable to meet with these types of schools, therefore, we
wanted to make sure that we would not only be able to evaluate the form splitting, but that we would also get
feedback on the overall form changes. Our respondents for this round of testing included Human Resources
employees and Payroll employees. Table 1 indicates the number respondents from each type of school with
whom we met.
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Table 1: Types of government entities by form type.
Type of School

New Form
Number

Number of
Respondents

Elementary/Secondary and
Post-Secondary

E-6

1*

Post-Secondary

E-10

2

Elementary/Secondary

E-8

7

* Based on the sample file we used for recruiting, we initially thought we recruited three E-6 –type schools. However, once we met with two of these
schools, we discovered that they were incorrectly classified. Both school systems only offered Elementary/Secondary educational programs.

Materials
The two new forms we tested in this round were identical to the E-6 form, except they contained only the fromspecific and payroll sections. Also, in an effort to reduce the form length, ASPEP staff reduced the number of
pay-intervals that respondents can record across all of the ASPEP forms. The forms now only have space for two
pay intervals. Appendix A contains all three questionnaires we evaluated in this round of testing.
Procedures
We conducted our interviews using concurrent and retrospective think-aloud techniques, with follow-up probes.
We gave respondents copies of the form, along with verbal instructions to complete it, but not to report actual
data if doing so would be inconvenient or time-consuming. Most respondents used data from a previouslycompleted form to complete the current form.
As respondents went through the form, we observed how they navigated from question to question and page to
page. We asked non-leading questions about their impressions of the layout and instructions. We nondirectively probed their responses until we had a thorough and accurate understanding of their perceptions.
Appendix B contains a copy of the protocol we used for cognitive interviewing.
In this report, we present our overall findings and recommendations for all three forms first. Because all three
forms contain the same questions and question wording, we will not discuss the forms separately. However, we
will present item-specific recommendations.

E-4 Findings and Recommendations
In this section of the report, we present or findings and recommendations from all three forms.
Finding #1: Overall impressions of the forms
Overall, respondents tended to like the redesigned forms. Our respondents in this round of testing echoes what
we heard in the previous rounds of testing. They like the “clean” look of the form. They also liked the vertical
alignment of the full-time and part-time employees and payroll. For one school, the horizontal alignment of the
two categories on the previous form resulted in a response error. This respondent reported the total number of
hours for both full-time and part-time on their 2012 form. It was not until she saw that the “Hours” answer
boxes were associated with the “Part-time Employee” section of the form that she realized her error on the
previous year’s form. The redesign was successful at keeping her from perpetuating the response error.
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Most of our respondents did not express an explicit preference for the new form. However, they did indicate the
features that they liked. One respondent preferred the old form to the new form. She indicated that she
preferred the old form because she liked the open boxes and the zeroes that were included in the answer blanks
for Part 2.
Recommendation: None
Finding #2: Form splitting –E-8 and E-10
During this round of testing, we met with nine schools that will be receiving one of the new, tailored forms. Only
two of these respondents actually noticed the fact that the form was shorter. However, we pointed out to the
other respondents that the form was more specifically tailored to their school’s educational program and asked
for their reactions to that change. All of our respondents liked the change to the forms. As one respondent said,
“shorter is better.” It is worth noting that none of the respondents who had previously filled out the E-6 form
had any problems with it. They were able to locate the applicable sections on the form. However, they still
preferred a more relevant, tailored form.
Recommendation: None
Finding #3: Multiple Pay intervals
For the 2013 data collection year, the ASPEP forms will have answer spaces for respondents to record up to two
different pay intervals. If the government or school has more than two pay intervals for employees, respondents
need to make copies of the pages on which they will record the pay intervals. Previous versions of the form
have allowed respondents to record up to three different pay intervals for employees before needing to make
copies of the from. However, ASPEP staff researched the frequency with which governments record more than
two pay intervals for their employees, and found the incidence to be somewhat infrequent. As a result of this
analysis, in an effort to reduce the number of pages on all of the ASPEP forms, the ASPEP staff eliminated the
response boxes for a third pay interval.
This change to the number of pay intervals that respondents can record created a problem for one of the
schools with which met. This school system pays all full-time employees on a bi-weekly basis, some of the parttime instructional personnel on a monthly basis, and some of their part-time non-instructional staff (coaches) on
a quarterly basis. When recording the payroll information in the instructional and non-instructional portions of
the form, the respondent did not encounter any problems. Each category of employee only had two codes.
However, when the respondent reached the “Total” section of Part 2, she realized that there was only space to
record two of the three pay intervals for her employees. The respondent was confused as to how she was
supposed to record the third pay interval on the form. She ultimately decided to write in the total for the third
pay interval underneath the answer boxes for the total. Because this respondent wrote outside of the valid text
entry boxes, the iCADE system most likely would either miss these additional lines of data, necessitating the
hand-keying of the information.
Compounding the problem was the fact that although the respondent read through the instructions carefully
she did not notice the instruction at the beginning of Part 2 that indicated what she should do if she needed
additional lines to enter more than two pay intervals. When we pointed out the instruction, which read, “If more
than two pay intervals need to be reported, please photocopy the necessary pages and include them with the
form,” the respondent still did not understand what she needed to do. Because the rest of the form refers to
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“Payroll codes” not “pay intervals,” it was not clear that this instruction applied to how she should record more
than two pay intervals. Also, she indicated that the instruction did not tell her where she should record the third
pay interval employees. The instruction only indicates that she should make copies of pages, not that she should
fill out the additional pages. She also noted that instruction should indicate that copies should be made before
the respondent fills out the form, other wise they will have filled in the answer spaces they need. The
instructions should explicitly state that the respondents should make copies of the pages for the sections of the
form that require more than two pay intervals before they begin filling out the form.
Recommendations: To help circumvent the problem of respondents writing in data for additional pay
intervals we recommend the following changes:
Add additional lines for more than two pay intervals in the “Total” section of Part 2. This change
could be implemented for all ASPEP forms.
Make the instructions on how to record more than two pay intervals more prominent at the
beginning of Part 2, either by bolding or by italicizing the instruction.
Make the instruction that respondents need to make copies of the pages first, then fill them out
more clear. The revised instruction could read:
“If more than two pay intervals need to be reported, please fill out this form online or
first photocopy the pages where you need more than two lines, use the copies to fill-in
the additional information, and return them with the form.”
Also, consider repeating the instruction at the beginning each subsection of employees.
Finally, consider requiring respondents with more than two pay intervals to report online. It
would not only reduce respondent confusion and reporting errors, but also reduce costs.
Resolutions:
ASPEP staff agreed to add two additional pay interval response lines in the “Total” section on all
the ASPEP forms.
They also will bold the instruction on how respondents should make copies of the pages and fill
out the section for which they need more than two lines for the pay frequencies. The revised
wording will read:
“If more that two pay intervals need to be reported, please fill out this survey online.
To fill it out on paper, first photocopy the pages where you will need to report more
than two pay intervals, use the copies to fill in the additional information, and return
them with the form.”
Finding #4: Misclassification errors
We encountered a few classification errors during our evaluation. The sample file we used for recruiting
indicated what type of forms the schools systems would get after the form splitting. Based on the classification
information in that file, we recruited three schools that were listed as offering both Elementary/Secondary and
Post-secondary educational programs and as receiving the E-6 form in the future. However, when we met with
two of these schools, the respondents indicated that their schools do not offer any Post-secondary education.
Accordingly, these schools should receive the E-8 form. There may be additional errors on the sample frame
that we did not detect in our testing.
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We also met with a school system that was receiving multiple forms for the individual Elementary/Secondary
schools within her city’s school system. She had previously filled out the individual forms (however, she has not
reported for the city in recent waves of data collection). During our discussion, we discovered that she did not
need to receive these individual forms. She could report for all of the city’s schools on one E-8 form. Given the
errors we found in the sample frame file and the importance of accurate frame data for the division of this from,
we advise the ASPEP staff to review that sample frame carefully to ensure that school systems have the correct
classification.
Recommendation: None
Finding #5: Online Reporting
Most of our respondents indicated that they preferred to respond to the survey online. At the end of our
testing, we asked these respondents who preferred to fill out the form electronically if they would like to receive
a paper form in the mail, or if they instead would like to receive a reminder letter with their username and
password (and instructions on how to request a paper form, should they want one). Only one of the
respondents indicated that she preferred to receive a paper form. The remaining respondents indicated that
they did not need to receive the paper form as long as they were able to print out a blank copy of the form from
the online interface. These respondents indicated that they get similar “invitations” from other forms that they
file on behalf of the State, making it a familiar method. Sending out paper forms, especially to respondents who
have historically reported online can be costly. Encouraging online response could create the opportunity for
cost savings.
Recommendation: Consider a small-scale pilot experiment of an electronic only mail out in the next
production cycle. Conducting respondent debriefings based on a pilot experiment also could provide
additional information on how respondents reacted to the online response push. Finally, consider using
an online-only follow-up with nonresponding governments.
Resolution: The survey sponsors have agreed to conduct a pilot experiment on an “Internet Only” survey
invitation during the 2013 data collection cycle. RIRS will work closely with the ASPEP staff to plan the
pilot experiment.

Item-specific Findings and Recommendations
In this section of the report, we detail our findings and recommendations for specific items on the
questionnaires.
Finding #6: Item 2 – Full-time hours
Item 2 has respondents to report the hours for full-time employees work. In past rounds of testing, this item
appears to be particularly problematic for school systems because they of the differences in the number of
hours instructional and non-instructional staff work. Teachers tend to work fewer hours per week, while noninstructional staff tends to work more hours per week. Respondents either were unsure how to answer this item
or provided an incorrect response. We observed similar problems in this round of testing.
One respondent answered this question in correctly. Her error was the result of the question wording. The item
uses the term “on average.” Based on the mention of an average this respondent answered the question based
on calculating the arithmetic mean number of hours for all employees, not on the hours the majority of the
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employees work. Factoring in the non-instructional employees, the average number of hours she computed was
higher than the number of hours the majority of the employees, the teachers, worked.
Recommendation: Remove the reference to “on average” from the question wording. A revised version
of the question might read:
“Approximately how many hours per week do the majority of your full-time employees work?”
Resolution: ASPEP staff has agreed to make the recommended changes to this item.
Finding #7: Part 2 instructions and example
In the previous round of testing, we observed numerous problems with the example on all of the ASPEP forms.
Respondents thought the example was a valid data-entry field. Based on our recommendation, ASPEP staff
added a watermark to the example to make it clear that the respondents that it was not a valid data-entry field.
In this round of testing, we did not observe any problems with the example. The watermark seemed to have
eliminated the problem. Respondents in this round not only noticed the example, they indicated that they found
it helpful toward figuring out how to fill out the form.
Other than the problem we identified in Finding 3, respondents in this round of testing also found the
instructions to be clear and helpful. They especially like the bulleted instructions for the subsections of Part 2,
which indicate who the respondent should include in the employee categories. They felt that this new format
was easier to read than the small, right-justified print on the old version of the form. However, as with previous
rounds of testing, respondents did comment that there were a lot of instructions, some of which seemed too
obvious. For example, one respondent felt that she did not need to see the “Do not report” instructions,
because she would never include that information in her data. However, as one respondent astutely pointed
out, the detailed instructions are useful when filling out the form for the first time.
Recommendations: None
Finding #8: Part 2 section headers
The section headers for the new E-8 and E-10 forms, which were not changed from the E-6 form, caused some
problems for respondents in this round of testing. We observed two response errors that were the result of the
section headers. Both of these response errors seem to be the result of not updating the headers after the split
from the E-6 form.
First, one respondent to the E-8 form incorrectly filled in the total number of employees in the “Instructional
staff” section of the form because she did not notice the “Instructional staff” section header. The capitalized and
bolded superordinate section header, “A. ELEMENTARY AND SECONDARY EDUCATION,” “over-shadowed” the
non-capitalized subsection header.
Because the old E-6 form had both types of educational programs, it was necessary to include the capitalized
header that identified the type of educational program that the respondent should report. However because
both the E-8 and E-10 forms will only have one type of educational program, the educational program header is
no longer necessary (and may not be compliant with the form standards because there are no additional
sections after section A). Following this convention, the “Instructional staff” header would be the superordinate
category.
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Second, another respondent to the E-8 from attempted to repeat her total number of instructional employees in
the “Total” section of the form. Because the section header read, “ELEMENTARY AND SECONDARY EDUCATION
TOTAL,” she thought it was asking for the only employees involved in delivering the educational services, making
this section redundant with the “Instructional staff” section. She expressed frustration at having to repeat the
information. If the header had not included the modifier, “Elementary and Secondary education” the
respondent would not have been confused. This header is the same header that appears on the E-6 form, when
it was necessary to specify what total the respondents should report. Because this form is now school-specific,
the detailed header is not necessary.
Recommendations:
Revise the headers on the E-8 and E-10 form to make the reporting categories more noticeable.
Make sure they are consistent with form standards.
Eliminate the “Elementary and Secondary education” and “College and other Post-secondary
education” modifiers from the E-8 and E-10 forms, respectively.
Resolutions: ASPEP staff will make the recommended changes to the outline structure of the form.

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Appendix A: Cognitive Interview Protocol
Research Goals:
Do the tailored forms work for respondents?
How do respondents react to the form changes?
Before the Questionnaire:
What types of services does this government entity provide?
What is your role in this government entity? What kind of responsibilities do you have?
What was your role in the process for responding to this questionnaire? (Gathered data? Compiled
data? Checked data? Authorized release?)
General Probes
Reflect back R’s specific answer: “you said…”
In your own words, what is this question asking?
How did you arrive at this number/answer this question? / Tell me how you arrived at these answers.
What did you include in this number? What did you specifically exclude?
What records (if any) did you look at? Were any other people involved in the process of coming up with
this number? [If Yes] What departments are they in?
How well does this data request match with your records?
Item 2 - FT Hours
Warm-up probes:
What is this question asking you?
How did you arrive at your answers?
What does the term “full time employees” mean to you?
Part 2: Employees, Payroll, & PT Hours
Part 2 Instructions and Example:
The example and instructions bridge two pages. Make a note of how the R grapples with the layout.
Did you notice the example?
o What did you think it was telling you?
o Was it clear? Did it help you figure out what you needed to know to fill out the form? If not,
what could we do to make it more helpful?
Did you notice the instructions?
o What did you think they were telling you?
o Were they clear? Did they help you figure out what you needed to know to fill out the
form? If not, what could we do to make them more helpful?
o Anything missing? Anything that shouldn’t be there?
Did you notice the payroll frequency codes? [And at the top of the pages]
o What did you think it was telling you?
o Was it clear? Did it help you figure out what you needed to know to fill out the form?
o Are they easy or difficult to find?
o Was it helpful having them at the top of the page?
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Part 2 Reporting:
Make careful note how respondents grapple with the new layout.
How did you arrive at your answer to this question?
Did you have any difficulty figuring out how to report information in this question? Make sure that
respondents do not have more than two pay frequencies. (Why?)
FOR ELEMENTARY/SECONDARY SCHOOLS
Do you offer any post-secondary education? If yes, how would you report those employees on this
form?
FOR POST-SECONDARY SCHOOLS
Do you offer any elementary or secondary education? If yes, how would you report those employees on
this form?
FOR SCHOOLS WITH BOTH TYPES OF PROGRAMS
If respondent only reports one type of education: I noticed that you only filled out the [elem/secondary /
post-secondary]. Do you have the other type of education programs?
What made you decide not to report those employees and payroll amounts? Find out why the
respondent appeared to report only one type of educational program. Did the respondent leave them off
or report them elsewhere?
Wrap-up Questions
What, if anything do you like about the form that we showed you today?
What if anything do you not like about the form we showed you today?
(Show them the other version of the form.) Which version of the form do you like better? Why?
About how long would it take you to complete this form (estimate in hours)?
(If R hasn’t indicated reporting online) Do you think you would fill this form out online?
If you respond online, would you like to receive a paper form in the mail, or would you like to receive a
notification to report online without receiving a paper form?

ASPEP E-6 Split Testing
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Appendix B: Questionnaires Used During Cognitive Testing

ASPEP E-6 Split Testing
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U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

E-6

2013 ANNUAL
SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
March 2013 – School Systems
OMB No. 0607-0452: Approval Expires 03/31/2015

(08-31-2012) Draft 5

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

Need help or have
questions?
• Visit
census.gov/govs/apes
• Call
1-800-832-2839 weekdays,
7am to 5pm ET
• Email
[email protected]
In correspondence
pertaining to this report,
please refer to the User ID
below the address box.

REPORT ONLINE: It’s fast and secure. Respond
to this survey via the Internet at the following web
address using the supplied User ID and Password:
respond.census.gov/aspep

User ID:
➤

Password:

GENERAL INSTRUCTIONS
Please use a black or blue ballpoint pen. Do not use pencil or felt tip pen.

1 Is your addressee title/department and mailing address the same as shown in the address label?
Mark "X" only one box.
Yes – Go to 2

No – Enter correct information below

ATTN:
Street 1

19063015

§4’?0¤

Addressee Title or Department

Street 2

City

State

Zip Code

Please continue on the next page

Page 2
PART 1 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

2 On average, how many hours per week do the majority of your full-time employees work?
Include
• Persons paid to work the number of hours that represents regular, full-time employment.
• Temporary or seasonal employees who are working the number of hours that represents regular, full-time
employment.
Exclude
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees.
Mark "X" only one box.
A

40 hours or more

C

34 to 37.4 hours

E

30 to 31.9 hours

B

37.5 to 39.9 hours

D

32 to 33.9 hours

F

No Full-Time Employees

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS

HOW TO
REPORT
DOLLAR
FIGURES

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.)
$Bil.

Mil.

Thou.

Dol.

1 2 3

4 5 6

7 8 0

INCORRECT marking example –
Do not put slashes through "0" or "7".
$Bil.

Mil.

Thou.

Dol.

7

8 9 0

3 For each applicable pay period that includes March 12, 2013, what were the TOTAL number of
employees and TOTAL gross payroll amounts for both full-time and part-time employees? Please also
report the number of part-time hours paid for each applicable pay period with part-time employees.
Payroll Codes
W = Weekly;

EXAMPLE

B = Bi-Weekly;

T = Twice a Month;

M = Monthly;

Q = Quarterly;

S = Semi-Annually;

A = Annually

E

If all full-time employees are paid bi-weekly, please provide the one bi-weekly payroll that includes March 12, 2013.
1. Full-time employees and gross payroll

➥

Full-time
Number of
Payroll
Full-time Employees
Code

B

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

1 5 6

2 9 5

M

P

9 3 2

L

If some part-time employees are paid bi-weekly and some part-time employees are paid monthly; please provide the data for
the one bi-weekly payroll that includes March 12, 2013 for the employees paid bi-weekly and the monthly data for the month
of March for the employees paid monthly.

A

Form E-6

➥

Part-time
Number of
Payroll
Part-time Employees
Code

B
M

1

E

X

$Bil.

Gross Payroll for Full-time Employees
Mil.
Thou.
Dol.

Part-time Hours Paid

0 3

6 3

0 7 7

2 2 5 2

4 1

5 5

5 9 0

1

9 8 5

Please continue on the next page

19063023

§4’?8¤

2. Part-time employees, gross payroll, and hours

Page 3
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)
If more than two payroll intervals need to be reported, please report online or photocopy the necessary pages and
return them with the form.
Include
Employees
• Current employees in paid leave status whether paid from the general, special or Federal grant funds
• Substitute teachers and student employees
• Board members or school trustees paid on a per meeting basis or a flat sum quarterly, semiannually, or
annually
• Temporary or seasonal employees working the number of hours that represent full-time employment should
be reported as full-time employees
• Part-time, temporary, or seasonal employees working less than the regular, full-time workweek should be
reported as part-time employees
Payroll
• Salaries, wages, fees or commissions, as well as overtime, premium and night differential pay
• Bonuses and incentive payments that are paid at regular pay intervals
• Amounts withheld for taxes, employee contributions to retirement systems, etc.
Hours
• An estimate of hours worked during the pay interval for part-time employees, not compensation on an
hourly basis
Exclude
Employees
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees
• School board members or school trustees who serve without compensation
Payroll
• Lump sum payments and the value of living quarters and subsistence allowances furnished to
employees
Do not 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.
A.

ELEMENTARY AND SECONDARY EDUCATION
Report here all employees of your school system except those concerned solely with college and other
postsecondary level education (about grade 12), who are to be reported in Section B.
W = Weekly;

1.

B = Bi-Weekly;

Instructional personnel

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

012

Include
• Teachers, teacher’s aides, substitute teachers
• Principals, supervisors of instruction, superintendents
• School librarians, guidance personnel, psychological personnel
a. Full-time employees and gross payroll

Form E-6

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

19063031

§4’?@¤

Full-time
Number of
Payroll
Full-time Employees
Code

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

Please continue on the next page

Page 4
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

2.

B = Bi-Weekly;

T = Twice a Month;

All other school system employees

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

112

Include
• Administrative and clerical personnel
• Plant operations, maintenance and custodial personnel
• Cafeteria
• Bus transportation
• Health and recreation
• Student employees
• Support staff for school districts
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

3.

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

ELEMENTARY AND SECONDARY EDUCATION TOTAL – (Sum of items 1. through 2.)
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

Form E-6

Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

19063049

§4’?R¤

b. Part-time employees, gross payroll, and hours

Please continue on the next page

Page 5
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B.

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

COLLEGE AND OTHER POSTSECONDARY EDUCATION
Report here only those persons employed in college and other postsecondary activities (above grade 12).
4.

Instructional staff

018

Include
• Employees engaged in college or other post-secondary level teaching and related academic
(departmental) research
• Employees engaged in continuing education and other non-degree programs that are operated by
degree granting institutions
• Adjunct professors and graduate teaching/research assistants (report as part-time)
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

5.

All other

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

016

Include
• All non-instructional employees of your college or other postsecondary level institution not reported
above
• All paid student help
• Administrative, clerical, custodial, cafeteria, and health personnel
• Non-instructional employees engaged in organized research, law enforcement personnel
a. Full-time employees and gross payroll

Form E-6

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

19063056

§4’?Y¤

Full-time
Number of
Payroll
Full-time Employees
Code

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

Please continue on the next page

Page 6
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

6.

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

COLLEGE AND POSTSECONDARY EDUCATION TOTAL – (Sum of items 4. through 5.)
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

PART 3 – REMARKS

4 Use this space to:
a) Explain any significant changes to employment or payroll occurring within the last year that would
aid in understanding this report;
b) List the groups of employees for which you were unable to supply information;
c) Indicate if the majority of your full-time employees work more than 40 hours per week on average.

PART 4 – CONTACT INFORMATION

5 Who should be contacted to answer questions about data reported on this form?

§4’?a¤

Area code and phone number

E-mail Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

Date form was completed
(MM)
(DD)
(YYYY)

Thank you for completing this form.
Retain a copy of the completed questionnaire for your records.
NOTE: The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This form has been approved by the Office of Management
and Budget (OMB) and given the number 0607-0143. Please note the number displayed in the upper right-hand corner of this form. Display of this number confirms that we have approval
from OMB to conduct this survey. If this number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided on this questionnaire compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13, United States Code, Section 9.
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 population served, and the extent and complexity
of their activities. Public reporting burden for this collection of information is estimated to vary from 30 minutes to 2 hours per response, with an average of 45 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0143,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use Paperwork Project 0607-0143 as the subject.

Form E-6

19063064

Name of contact person - Please print

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

E-8

2013 ANNUAL
SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
March 2013 – School Systems
OMB No. 0607-0452: Approval Expires 03/31/2015

(09-05-2012) Draft 1

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

Need help or have
questions?
• Visit
census.gov/govs/apes
• Call
1-800-832-2839 weekdays,
7am to 5pm ET
• Email
[email protected]
In correspondence
pertaining to this report,
please refer to the User ID
below the address box.

REPORT ONLINE: It’s fast and secure. Respond
to this survey via the Internet at the following web
address using the supplied User ID and Password:
respond.census.gov/aspep

User ID:
➤

Password:

GENERAL INSTRUCTIONS
Please use a black or blue ballpoint pen. Do not use pencil or felt tip pen.

1 Is your addressee title/department and mailing address the same as shown in the address label?
Mark "X" only one box.
Yes – Go to 2

No – Enter correct information below

ATTN:
Street 1

19083013

§4)?.¤

Addressee Title or Department

Street 2

City

State

Zip Code

Please continue on the next page

Page 2
PART 1 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

2 On average, how many hours per week do the majority of your full-time employees work?
Include
• Persons paid to work the number of hours that represents regular, full-time employment.
• Temporary or seasonal employees who are working the number of hours that represents regular, full-time
employment.
Exclude
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees.
Mark "X" only one box.
A

40 hours

C

34 to 37.4 hours

E

30 to 31.9 hours

B

37.5 to 39.9 hours

D

32 to 33.9 hours

F

No Full-Time Employees

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS

HOW TO
REPORT
DOLLAR
FIGURES

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.)
$Bil.

Mil.

Thou.

Dol.

1 2 3

4 5 6

7 8 0

INCORRECT marking example –
Do not put slashes through "0" or "7".
$Bil.

Mil.

Thou.

Dol.

7

8 9 0

3 For each applicable pay period that includes March 12, 2013, what were the TOTAL number of
employees and TOTAL gross payroll amounts for both full-time and part-time employees? Please also
report the number of part-time hours paid for each applicable pay period with part-time employees.
Payroll Codes
W = Weekly;

EXAMPLE

B = Bi-Weekly;

T = Twice a Month;

M = Monthly;

Q = Quarterly;

S = Semi-Annually;

A = Annually

E

If all full-time employees are paid bi-weekly, please provide the one bi-weekly payroll that includes March 12, 2013.
1. Full-time employees and gross payroll

➥

Full-time
Number of
Payroll
Full-time Employees
Code

B

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

1 5 6

2 9 5

M

P

9 3 2

L

If some part-time employees are paid bi-weekly and some part-time employees are paid monthly; please provide the data for
the one bi-weekly payroll that includes March 12, 2013 for the employees paid bi-weekly and the monthly data for the month
of March for the employees paid monthly.

A

Form E-8

➥

Part-time
Number of
Payroll
Part-time Employees
Code

B
M

1

E

X

$Bil.

Gross Payroll for Part-time Employees
Mil.
Thou.
Dol.

Part-time Hours Paid

0 3

6 3

0 7 7

2 2 5 2

4 1

5 5

5 9 0

1

9 8 5

Please continue on the next page

19083021

§4)?6¤

2. Part-time employees, gross payroll, and hours

Page 3
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)
If more than two payroll intervals need to be reported, please report online or photocopy the necessary pages and
return them with the form.
Include
Employees
• Current employees in paid leave status whether paid from the general, special or Federal grant funds
• Substitute teachers and student employees
• Board members or school trustees paid on a per meeting basis or a flat sum quarterly, semiannually, or
annually
• Temporary or seasonal employees working the number of hours that represent full-time employment should
be reported as full-time employees
• Part-time, temporary, or seasonal employees working less than the regular, full-time workweek should be
reported as part-time employees
Payroll
• Salaries, wages, fees or commissions, as well as overtime, premium and night differential pay
• Bonuses and incentive payments that are paid at regular pay intervals
• Amounts withheld for taxes, employee contributions to retirement systems, etc.
Hours
• An estimate of hours worked during the pay interval for part-time employees, not compensation on an
hourly basis
Exclude
Employees
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees
• School board members or school trustees who serve without compensation
Payroll
• Lump sum payments and the value of living quarters and subsistence allowances furnished to
employees
Do not 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.
A.

ELEMENTARY AND SECONDARY EDUCATION
Report here all employees of your school system.

W = Weekly;

1.

B = Bi-Weekly;

Instructional personnel

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

012

Include
• Teachers, teacher’s aides, substitute teachers
• Principals, supervisors of instruction, superintendents
• School librarians, guidance personnel, psychological personnel
a. Full-time employees and gross payroll

Form E-8

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

19083039

§4)?H¤

Full-time
Number of
Payroll
Full-time Employees
Code

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

Please continue on the next page

Page 4
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

2.

B = Bi-Weekly;

T = Twice a Month;

All other school system employees

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

112

Include
• Administrative and clerical personnel
• Plant operations, maintenance and custodial personnel
• Cafeteria
• Bus transportation
• Health and recreation
• Student employees
• Support staff for school districts
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

3.

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

ELEMENTARY AND SECONDARY EDUCATION TOTAL – (Sum of items 1. through 2.)
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

Form E-8

Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

19083047

§4)?P¤

b. Part-time employees, gross payroll, and hours

Please continue on the next page

Page 5
PART 3 – REMARKS

4 Use this space to:
a) Explain any significant changes to employment or payroll occurring within the last year that would
aid in understanding this report;
b) List the groups of employees for which you were unable to supply information;
c) Indicate if the majority of your full-time employees work more than 40 hours per week on average.

PART 4 – CONTACT INFORMATION

5 Who should be contacted to answer questions about data reported on this form?

§4)?W¤

Area code and phone number

E-mail Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

Date form was completed
(MM)
(DD)
(YYYY)

Thank you for completing this form.
Retain a copy of the completed questionnaire for your records.
NOTE: The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This form has been approved by the Office of Management
and Budget (OMB) and given the number 0607-0452. Please note the number displayed in the upper right-hand corner of this form. Display of this number confirms that we have approval
from OMB to conduct this survey. If this number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided on this questionnaire compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13, United States Code, Section 9.
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 population served, and the extent and complexity
of their activities. Public reporting burden for this collection of information is estimated to vary from 30 minutes to 2 hours per response, with an average of 45 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0143,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use Paperwork Project 0607-0143 as the subject.

Form E-8

19083054

Name of contact person - Please print

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

2013 ANNUAL
SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
March 2013 – School Systems

E-10 (09-05-2012) Draft 1

OMB No. 0607-0452: Approval Expires 03/31/2015

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

Need help or have
questions?
• Visit
census.gov/govs/apes
• Call
1-800-832-2839 weekdays,
7am to 5pm ET
• Email
[email protected]
In correspondence
pertaining to this report,
please refer to the User ID
below the address box.

REPORT ONLINE: It’s fast and secure. Respond
to this survey via the Internet at the following web
address using the supplied User ID and Password:
respond.census.gov/aspep

User ID:
➤

Password:

GENERAL INSTRUCTIONS
Please use a black or blue ballpoint pen. Do not use pencil or felt tip pen.

1 Is your addressee title/department and mailing address the same as shown in the address label?
Mark "X" only one box.
Yes – Go to 2

No – Enter correct information below

ATTN:
Street 1

19103019

§4+?4¤

Addressee Title or Department

Street 2

City

State

Zip Code

Please continue on the next page

Page 2
PART 1 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

2 On average, how many hours per week do the majority of your full-time employees work?
Include
• Persons paid to work the number of hours that represents regular, full-time employment.
• Temporary or seasonal employees who are working the number of hours that represents regular, full-time
employment.
Exclude
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees.
Mark "X" only one box.
A

40 hours

C

34 to 37.4 hours

E

30 to 31.9 hours

B

37.5 to 39.9 hours

D

32 to 33.9 hours

F

No Full-Time Employees

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS

HOW TO
REPORT
DOLLAR
FIGURES

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.)
$Bil.

Mil.

Thou.

Dol.

1 2 3

4 5 6

7 8 0

INCORRECT marking example –
Do not put slashes through "0" or "7".
$Bil.

Mil.

Thou.

Dol.

7

8 9 0

3 For each applicable pay period that includes March 12, 2013, what were the TOTAL number of
employees and TOTAL gross payroll amounts for both full-time and part-time employees? Please also
report the number of part-time hours paid for each applicable pay period with part-time employees.
Payroll Codes
W = Weekly;

EXAMPLE

B = Bi-Weekly;

T = Twice a Month;

M = Monthly;

Q = Quarterly;

S = Semi-Annually;

A = Annually

E

If all full-time employees are paid bi-weekly, please provide the one bi-weekly payroll that includes March 12, 2013.
1. Full-time employees and gross payroll

➥

Full-time
Number of
Payroll
Full-time Employees
Code

B

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

1 5 6

2 9 5

M

P

9 3 2

L

If some part-time employees are paid bi-weekly and some part-time employees are paid monthly; please provide the data for
the one bi-weekly payroll that includes March 12, 2013 for the employees paid bi-weekly and the monthly data for the month
of March for the employees paid monthly.

A

Form E-10

➥

Part-time
Number of
Payroll
Part-time Employees
Code

B
M

1

E

X

$Bil.

Gross Payroll for Part-time Employees
Mil.
Thou.
Dol.

Part-time Hours Paid

0 3

6 3

0 7 7

2 2 5 2

4 1

5 5

5 9 0

1

9 8 5

Please continue on the next page

19103027

§4+?<¤

2. Part-time employees, gross payroll, and hours

Page 3
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)
If more than two payroll intervals need to be reported, please report online or photocopy the necessary pages and
return them with the form.
Include
Employees
• Current employees in paid leave status whether paid from the general, special or Federal grant funds
• Substitute teachers and student employees
• Board members or school trustees paid on a per meeting basis or a flat sum quarterly, semiannually, or
annually
• Temporary or seasonal employees working the number of hours that represent full-time employment should
be reported as full-time employees
• Part-time, temporary, or seasonal employees working less than the regular, full-time workweek should be
reported as part-time employees
Payroll
• Salaries, wages, fees or commissions, as well as overtime, premium and night differential pay
• Bonuses and incentive payments that are paid at regular pay intervals
• Amounts withheld for taxes, employee contributions to retirement systems, etc.
Hours
• An estimate of hours worked during the pay interval for part-time employees, not compensation on an
hourly basis
Exclude
Employees
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees
• School board members or school trustees who serve without compensation
Payroll
• Lump sum payments and the value of living quarters and subsistence allowances furnished to
employees
Do not 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.

W = Weekly;

A.

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

COLLEGE AND OTHER POSTSECONDARY EDUCATION
Report here only those persons employed in college and other postsecondary activities (above grade 12).
1.

Instructional staff

018

Include
• Employees engaged in college or other post-secondary level teaching and related academic
(departmental) research
• Employees engaged in continuing education and other non-degree programs that are operated by
degree granting institutions
• Adjunct professors and graduate teaching/research assistants (report as part-time)

Form E-10

Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

19103035

§4+?D¤

a. Full-time employees and gross payroll

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

Please continue on the next page

Page 4
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

2.

All other

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

016

Include
• All non-instructional employees of your college or other postsecondary level institution not reported
above
• All paid student help
• Administrative, clerical, custodial, cafeteria, and health personnel
• Non-instructional employees engaged in organized research, law enforcement personnel
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

b. Part-time employees, gross payroll, and hours
Part-time
Number of
Payroll
Part-time Employees
Code

3.

Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

COLLEGE AND POSTSECONDARY EDUCATION TOTAL – (Sum of items 1. through 2.)
a. Full-time employees and gross payroll
Full-time
Number of
Payroll
Full-time Employees
Code

Gross Payroll for Full-time Employees
$Bil.
Mil.
Thou.
Dol.

b. Part-time employees, gross payroll, and hours
Gross Payroll for Part-time Employees
$Bil.
Mil.
Thou.
Dol.

Part-time Hours Paid

Form E-10

19103043

§4+?L¤

Part-time
Number of
Payroll
Part-time Employees
Code

Please continue on the next page

Page 5
PART 3 – REMARKS

4 Use this space to:
a) Explain any significant changes to employment or payroll occurring within the last year that would
aid in understanding this report;
b) List the groups of employees for which you were unable to supply information;
c) Indicate if the majority of your full-time employees work more than 40 hours per week on average.

PART 4 – CONTACT INFORMATION

5 Who should be contacted to answer questions about data reported on this form?

§4+?S¤

Area code and phone number

E-mail Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

Date form was completed
(MM)
(DD)
(YYYY)

Thank you for completing this form.
Retain a copy of the completed questionnaire for your records.
NOTE: The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 182. This form has been approved by the Office of Management
and Budget (OMB) and given the number 0607-0452. Please note the number displayed in the upper right-hand corner of this form. Display of this number confirms that we have approval
from OMB to conduct this survey. If this number was not displayed, under the Paperwork Reduction Act, we could not request your participation in this voluntary survey. Information
provided on this questionnaire compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13, United States Code, Section 9.
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 population served, and the extent and complexity
of their activities. Public reporting burden for this collection of information is estimated to vary from 30 minutes to 2 hours per response, with an average of 45 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Paperwork Project 0607-0143,
U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use Paperwork Project 0607-0143 as the subject.

Form E-10

19103050

Name of contact person - Please print


File Typeapplication/pdf
File Modified2012-12-20
File Created2012-10-11

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