E-5 Worksheet 2015 Annual Survey of Public Employment & Paryoll March

Public Employment & Payroll Forms

Attachment 1 - e5_16_123015

Public Employment & Payroll Forms

OMB: 0607-0452

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0607-0452 can be found here:

2018-08-07 - Extension without change of a currently approved collection

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U.S. DEPARTMENT OF COMMERCE

Attachment 1

Economics and Statistics Administration

U.S. CENSUS BUREAU
Worksheet

E-5

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

(12-30-2015) 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&]4¤

Addressee Title or Department

ATTN:
Street 1

Street 2

City

State

Zip Code

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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

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WORKSHEET

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

2 Approximately how many hours per week do the majority of the full-time employees work?

Exclude
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees
Mark "X" only one box.
A

40 hours

34 to 37.4 hours

30 to 31.9 hours

37.5 to 39.9 hours

32 to 33.9 hours

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.

8 9 0

3 For each applicable pay period that includes March 12, 2016, 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.

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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

Payroll Codes
W = Weekly;

EXAMPLE

B = Bi-Weekly;

T = Twice a Month;

M = Monthly;

Q = Quarterly;

S = Semi-Annually;

A = Annually

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

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

1 5 6

2 9 5

9 3 2

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.

§4&]<¤

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

E-5

➥

Part-time
Number of
Payroll
Part-time Employees
Code

B
M

$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

9 8 5

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➥

Full-time
Number of
Payroll
Full-time Employees
Code

Page 3
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

CENTRAL GOVERNMENT ADMINISTRATION
Financial administration

023

Include
• Employees of treasurer’s, auditor’s or comptroller’s office
• Tax assessment, tax billing and collection employees
• Budgeting and purchasing employees
• Employees of central accounting offices
• Information technology employees
• Similar financial administration employees
a. Full-time employees and gross payroll

§4&]D¤

Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

Please continue on the next page

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E-5

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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.
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 $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.

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

W = Weekly;

B = Bi-Weekly;

Central administration

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

029

a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Number of
Part-time Employees

Judicial and legal

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

Part-time Hours Paid

025

a. Full-time employees and gross payroll

§4&]L¤
E-5

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

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Include
• Employees performing all court and court related activities, including court activities of sheriff’s
office (e.g., bailiffs, process servers)
• Prosecuting attorney’s and public defender’s offices employees
• Legal department employees and attorneys providing government-wide legal services
• Employees of law libraries
Exclude
• Private attorneys on retainer and court appointed attorneys
Full-time
Payroll
Code

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Include
• City, county, or township council, board of supervisors or commissioners
• Employees of central administrative offices and agencies, such as manager or mayor
• Clerk, recorder, and zoning employees
• Central personnel and employees of central planning agencies
Exclude
• Employees performing financial activities (should be reported in item 1.)
• Employees performing judicial and legal activities (should be reported in item 3.)

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

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

PUBLIC SAFETY
Fire protection
Exclude
• Forest fire protection employees
• Rescue squad and emergency medical services employees not part of fire department (should be
reported in item 8.)
a. Firefighters 024
Include
• Persons engaged in fire suppression and prevention
• Employees trained in these activities but performing other duties such as dispatching, emergency
medical care, etc.
• Paid volunteer firefighters (should be reported as part-time employees)
Exclude
• Unpaid volunteer firefighters
(1) Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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(2) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

124

§4&]S¤

Include
• All fire protection employees not reported in item 4a.
• Fire administrative staff
• If handled by the fire department: Emergency (911) dispatching & emergency medical technicians (EMTs)
(1) Full-time employees and gross payroll

E-5

Full-time
Payroll
Code

Number of
Full-time Employees

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

(2) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

Part-time Hours Paid

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b. Other fire protection employees

Part-time Hours Paid

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

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

Police protection

a. Persons with power of arrest

062

Include
• Police employees only
Exclude
• Other employees with power of arrest (should be reported in item 3.)
(1) Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

(2) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

162

Include
• All police protection employees not reported in item 5a.
• Coroners and crime lab employees
• School crossing guards (should be reported as part-time employees)
• Police administrative staff
• If handled by the police department: Emergency (911) dispatching
(1) Full-time employees and gross payroll

§4&]e¤

Full-time
Payroll
Code

E-5

Number of
Full-time Employees

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

(2) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

Part-time Hours Paid

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b. Other police protection employees

Part-time Hours Paid

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Include
• Police department, law enforcement and lock-up employees
• Employees performing activities of sheriff’s and constable’s offices

Page 7
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

TRANSPORTATION
Streets and highways

044

Include
• Employees performing maintenance, repair, construction, and administration of streets, alleys,
sidewalks, roads, highways, bridges, and terminal and dock facilities for public ferries
• Employees performing engineering activities
• Employees performing traffic signal maintenance
Exclude
• Street cleaning employees (should be reported in item 10.)
• Sewer employees (should be reported in item 11.)
a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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

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

Part-time Hours Paid

SOCIAL SERVICES AND INCOME MAINTENANCE
7.

Public welfare

079

Include
• Employees performing maintenance of homes and other institutions for the needy
• Nursing home employees and social workers
• Employees performing administration of public assistance and veteran services
• Senior citizen and handicap transportation employees
Exclude
• Hospital employees (should be reported in item 9.)

§4&]m¤

a. Full-time employees and gross payroll

E-5

Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

Please continue on the next page

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Number of
Part-time Employees

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Page 8
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

Health

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

032

a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Hospitals

Number of
Part-time Employees

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

Part-time Hours Paid

036

a. Full-time employees and gross payroll

§4&]u¤
E-5

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

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Include
• Employees of facilities providing inpatient medical care and institutions primarily for care and
treatment of handicapped persons
• Employees of institutions for the custody, treatment or general care of the mentally insane or
emotionally disturbed
• Maternity and children hospital employees
Exclude
• Nursing home and welfare institution employees (should be reported in item 7.)
Full-time
Payroll
Code

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Include
• Public health services and emergency medical services employees
• Mental health and outpatient clinics employees, visiting nurses, and animal control employees
• Alcohol and drug abuse employees
• Employees performing food and sanitary inspections
• Employees performing other environmental health activities (e.g., pollution control)
Exclude
• Coroners and crime lab employees (should be reported in item 5b.)

Page 9
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

ENVIRONMENT AND HOUSING
081

Include
• Recycling, garbage, and refuse collection and disposal employees
• Street cleaning employees
• Employees performing sanitary landfill operations
a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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

11. Sewerage

Number of
Part-time Employees

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

Part-time Hours Paid

080

a. Full-time employees and gross payroll

§4&]}¤
E-5

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

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Include
• Employees providing maintenance and operation of sanitary and storm sewer systems
• Sewerage disposal plant employees
Exclude
• Water supply employees (should be reported in item 13.)
Full-time
Payroll
Code

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10. Solid waste management

Page 10
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

12. Parks and recreation

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

061

Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

UTILITIES
13. Water supply system

091

a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

§4&^!¤

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

Number of
Part-time Employees

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

Part-time Hours Paid

Please continue on the next page

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Include
• Employees performing operation, maintenance, and construction of public water supply or
distribution systems

E-5

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Include
• Employees of parks, playgrounds, swimming pools, and golf courses
• Employees of auditoriums, museums, convention centers, and recreational centers
• Employees of marinas, zoos, and gardens
a. Full-time employees and gross payroll

Page 11
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

14. Electric power system

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

092

a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

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Include
• Employees performing operation, maintenance, and construction of public electric power supply or
distribution systems

OTHER ACTIVITIES
15. Libraries

052

Include
• Employees of all public libraries and technical support of the government for privately-owned
libraries

a. Full-time employees and gross payroll

§4&^3¤

Full-time
Payroll
Code

E-5

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

Please continue on the next page

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Exclude
• Employees of law libraries (should be reported in item 3.)

Page 12
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

16. All other

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

089

Exclude
• School system employees and payrolls
a. Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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

Number of
Part-time Employees

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

Part-time Hours Paid

(1) Job Function
Specify:
(a) Full-time employees and gross payroll

§4&^;¤

Full-time
Payroll
Code

E-5

Number of
Full-time Employees

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

(b) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

Part-time Hours Paid

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c. Please list the major job functions reported above in All other (16a. and 16b.)

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Include
• Employees performing other activities not reported elsewhere
• Employees concerned with elections and voter registration
• Protective inspection and enforcement employees (building, electrical, etc.)
• Motor pool, general public building maintenance, parking facilities, and engineering employees
• Emergency (911) dispatching employees not handled by the fire department and/or police department
• Employees providing county supervision of public school districts
• Homeland security and emergency management employees

Page 13
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

(a) Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

(b) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

Part-time Hours Paid

(3) Job Function
Specify:
(a) Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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(2) Job Function
Specify:

(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) Job Function
Specify:
(a) Full-time employees and gross payroll

§4&^C¤

Full-time
Payroll
Code

E-5

Number of
Full-time Employees

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

(b) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

Part-time Hours Paid

Please continue on the next page

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Part-time
Payroll
Code

Page 14
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

(a) Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

(b) Part-time employees, gross payroll, and hours
Part-time
Payroll
Code

Number of
Part-time Employees

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

Part-time Hours Paid

(6) Job Function
Specify:
(a) Full-time employees and gross payroll
Full-time
Payroll
Code

Number of
Full-time Employees

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

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(5) Job Function
Specify:

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

Part-time Hours Paid

§4&^K¤

Number of
Part-time Employees

E-5

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Part-time
Payroll
Code

Page 15
PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS – (Continued)

W = Weekly;

B = Bi-Weekly;

T = Twice a Month;

Payroll Codes
M = Monthly;
Q = Quarterly;

S = Semi-Annually;

A = Annually

17. TOTAL – (Sum of items 1. through 16.)
Full-time
Payroll
Code

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

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§4&^\¤

Part-time
Payroll
Code

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a. Full-time employees and gross payroll

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Page 16
PART 3 – REMARKS

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

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

§4&^d¤

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 15 minutes to 15 hours per response, with an average of 1¼ hours 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-5

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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

File Type	application/pdf
File Modified	2016-01-05
File Created	2015-12-30