E-3 Worksheet 2015 Annual Survey of Public Employment & Payroll March

Attachment 1
U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
Worksheet

E-3

2016 ANNUAL
SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
March 2016 – Special Districts and Local Agencies
OMB No. 0607-0452: Approval Expires 11/30/2018

(12-29-2015) Draft 3

DUE DATE:
DO NOT use this worksheet to respond to the survey, it is intended to assist you
with gathering and preparing your data prior to reporting online.

RETURN TO:

Return to respond.census.gov/aspep when you are ready to report online.

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.

User ID:
➤
Password:

GENERAL INSTRUCTIONS

1 Is the 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

§4$],¤

Addressee Title or Department

ATTN:
Street 1

Street 2

City

State

Zip Code

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to this survey via the Internet at the following Web
address using the supplied User ID and Password:
respond.census.gov/aspep

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WORKSHEET

Page 2

2

Does this agency currently have paid employees and/or paid officials? Mark "X" only one box.
Yes – go to 3

PART 1 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

3 Approximately how many hours per week do the majority of the 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

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No – go to 5

8 9 0

4 For each applicable pay period that includes March 12, 2016, what were the TOTAL number of

Payroll Codes
W = Weekly;

EXAMPLE

B = Bi-Weekly;

T = Twice a Month;

M = Monthly;

Q = Quarterly;

S = Semi-Annually;

§4$]>¤

E

If all full-time employees are paid bi-weekly, please provide the one bi-weekly payroll that includes March 12, 2016.
A. Full-time employees and gross payroll

E-3

A = Annually

➥

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

9 3 2

P

L

If some part-time employees are paid bi-weekly and some part-time employees are paid monthly; please provide the data for
the bi-weekly payroll that includes March 12, 2016 for the employees paid bi-weekly and the monthly data for the month of
March for the employees paid monthly.

A

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

➥

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

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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.

Page 3
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)
If more than two payroll codes need to be reported, please fill out this survey online. To continue filling
it out on paper, photocopy the pages where you need to record more than two payroll codes, use the
copies to fill out the additional information, and return them with the form.

$100 annually) or paid on salary basis; by fees or commissions; on a per meeting basis; or a flat sum quarterly,
semi-annually, or annually
• Temporary or seasonal employees working the number of hours that represent full-time employment should be
reported as full-time employees
• 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 periods
• Amounts withheld for taxes, employee contributions to retirement systems, etc.
Hours
• An estimate of hours worked during the pay period 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 system employees and payrolls
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;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

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Include
Employees
• Current employees in paid leave status whether paid from the general, special, or Federal grant funds
• All elected or appointed officials paid any amount of pay or stipend (even small amounts of $25 per meeting or

A = Annually

A. Full-time employees and gross payroll
Number of
Full-time Employees

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

B. Part-time employees, gross payroll, and hours
Number of
Part-time Employees

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

Part-time Hours Paid

§4$]F¤

Part-time
Payroll
Code

E-3

Please continue on the next page

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Full-time
Payroll
Code

Page 4
PART 3 – REMARKS

5 Use this space for any explanations that may be essential in understanding the reported data.

Please continue on page 10

6 Who should be contacted to answer questions about data reported on this worksheet?
Name of contact person - Please print

§4$]N¤

Area code and phone number

Email 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, Sections 161 and 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(b).
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 10 minutes to 1½ hours per response, with an average of 20 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: ECON Survey Comments 0607-0452,
U.S. Census Bureau, 4600 Silver Hill Road, EMD-8K122, Washington, DC 20233. You may e-mail comments to [email protected]; use ECON Survey Comments
0607-0452 as the subject.

E-3

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PART 4 – CONTACT INFORMATION

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Include
• Any significant changes to employment or payroll occurring within the last year
• Groups of employees for which you were unable to supply information
• A note if the majority of the full-time employees work more than 40 hours per week