Form cc-301 Equal Pay Report

EQUAL PAY REPORT

Office of Federal Contract O.M.B. No. _________

Compliance Programs (Labor) EXPIRES ___________

Section A – TYPE OF REPORT

Refer to instructions for number and types of reports to be filed.

1. Indicate by marking in the appropriate box(es) the type of reporting unit for which this report is submitted

Single Establishment Employer: Multi-establishment Employer:

 Single Establishment Report Headquarters Report

Establishment Report (Required for establishments of all sizes)

2. Total number of reports being filed by this Company (Answer on Headquarters Report only)

Section B – COMPANY IDENTIFICATION (To be answered by all employers)

1. Headquarters
Name of Headquarters (owns or controls establishment in item 2)
Address (Number and Street)
City or Town	State			ZIP Code
2. Establishment for which this report is filed.
Name of establishment
Address (Number and Street)		City or Town	County	State	ZIP Code
Employer identification No. (IRS 9-DIGIT Tax Number)
Was an Equal Pay Report filed for this establishment last year? Yes No

Section C – CONTRACTOR/SUBCONTRACTOR INFORMATION (To be answered by all contractors and subcontractors)

Please enter your:

Dun and Bradstreet identification number (if you have one): ______________________

North American Industry Classification System (NAICS) Code: ___________________

EEO-1 Unit Number: ______________________

EEO-1 Company Number: _________________

EEO-1 Job Category

Job Category Number

Section D – Male Employees

Hispanic or Latino

Non-Hispanic or Latino

Total

White

Black or African American

Native Hawaiian or Other Pacific Islander

Asian

American Indian or Alaska Native

Two or More Races

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

Total W-2 Pay

Total Work Hours

Executive/Sr Level Officials & Mgrs

1.1

First/Mid-Level Officials & Mgrs

1.2

Professionals

2

Technicians

3

Sales Workers

4

Administrative Support Workers

5

Craft Workers

6

Operatives

7

Laborers and Helpers

8

Service Workers

9

Total

10

EEO-1 Job Category

Job Category Number

Section D – Female Employees

Hispanic or Latino

Non-Hispanic or Latino

Total

White

Black or African American

Native Hawaiian or Other Pacific Islander

Asian

American Indian or Alaska Native

Two or More Races

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

W-2 Paid

Total Work Hours

Total Employees

Total W-2 Pay

Total Work Hours

Executive/Sr Level Officials & Mgrs

1.1

First/Mid-Level Officials & Mgrs

1.2

Professionals

2

Technicians

3

Sales Workers

4

Administrative Support Workers

5

Craft Workers

6

Operatives

7

Laborers and Helpers

8

Service Workers

9

Total

10

Section E – REMARKS (Include in this section any remarks, explanations, or other pertinent information regarding this report)

Section F – REPRESENTATION & CERTIFICATION

Check One: All the reports are accurate and were prepared in accordance with the instructions. (Check on Headquarters Report Only)

This report is accurate and was prepared in accordance with the instructions.

Name of Responsible Official	Title	Signature	Date
Contact Person for this Report	Title	Telephone Number (Including Area Code and Extension)	Email Address

Paperwork Reduction Act Notice: The Paperwork Reduction Act provides that, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection is estimated to average 6 hours for electronic filers, and 8 hours for filers using an alternative reporting format, such as filing through a paper version of the form. Send comments regarding this burden estimate to Division of Policy and Program Development, Office of Federal Contract Compliance Programs, Room C-3325, 200 Constitution Avenue, N.W., Washington, D.C. 20210. No express assurance of confidentiality is provided; however, Department of Labor regulations provide that a contractor affected by a FOIA disclosure request be notified in writing and no decision to disclose information is made until the contractor has an opportunity to submit objections to the release of the information.