Form NCS 15-1G NCS 15-1G Establishment Collection Form for Government

National Compensation Survey

NCS 15- 1G - EstabworklevelandscheduleformGOVT

National Compensation Survey (State and local government sample)

OMB: 1220-0164

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U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey


The BLS publishes statistical tabulations from this survey that may reveal the information reported by individual State and local governments. Upon your request, however, the BLS will hold the information provided on this survey form in confidence.

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


O.M.B. #1220-0164

Expires X/XX/XX

We estimate that it will take an average of 54 minutes to complete this form, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments regarding this estimate or any other aspect of this survey; including suggestions for reducing this burden, please send them to the Bureau of Labor Statistics, Office of Compensation and Working Conditions (1220-0164), 2 Massachusetts Avenue N.E., Washington, D.C. 20212. You are not required to respond to the collection of information unless it displays a currently valid OMB control number.

ESTABLISHMENT COLLECTION FORM FOR GOVERNMENT

(Work level and scheduling)


Address # 1.

Physical Address Personal Visit Address Mailing Address


Schedule Number(#):

Company Name:

Secondary Name (Doing Business As):

Address:

City/State/ZIP:

Address # 2.

Physical Address Personal Visit Address Mailing Address


Company Name:

Secondary Name (Doing Business As):

Address:

City/State/ZIP:



Establishment Officials (Contact List)

# 1: Authorizing Supplying

Title:

Telephone #:

FAX #:

E-mail:

Address: 1, 2, or COC. Mail forms to

# 2: Authorizing Supplying

Title:

Telephone #:

FAX #:

E-mail:

Address: 1, 2, or COC. Mail forms to

# 3: Authorizing Supplying

Title:

Telephone #:

FAX #:

Email:

Address: 1, 2, or COC. Mail forms to


NCS Form15-1G (2015)

Central Office Clearance (Complete if clearance and/or data obtained from this source)

Clearance obtained: Schedule (data) obtained:

Company Name:

Address:

City/State/ZIP:





Remarks





































COMPANY DATA

Establishment Information (current data) Schedule #:

State:

Collection Panel:

Sample Number:

Assigned Employment:

Total Employment:

PSO Employment:

NAICS:


Establishment Description:

Product Description:



Collection Information

Field Economist:

Method of Collection:

Collection Date:

Payroll Reference Date:



Respondent waived confidentiality Data obtained electronically


Document obtained (Secondary data source)


Written Permission: Yes, No

Name and Title of Official:

Date of Permission:

Permission on file at RO: Yes, No




Status (IDC Wage)

Establishment Status:

Remarks:


Usable



On strike



Vacant



Temporary non response



Refusal



Out of business



Out of scope



Abolished



No matching jobs



Duplicate





SMG Notification


Reason:

Remarks:

Ownership/NAICS change



Part of assigned unit



Collected unit larger than assigned



Employment +/- 20% of assigned



Employment up – business fluctuations



Sampled employment wrong



SMG chose establishment subsample



Overlap (set by system)



Other discrepancy





Remarks












































NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT





Remarks

























NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks























U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks























U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks






















U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT







Remarks






















U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks























U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT






Remarks























U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY - Leveling

Schedule Number:




Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTRACTS




PHYSICAL ENVIRONMENT






Remarks























U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY – Base Leveling Supervisor

Schedule Number:




Supervisor

1st 2nd 3rd Line Supervisor/Manager



Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:






Highest Level Non-Supervisory Subordinate Position _________________________________________________


Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT





Remarks



















U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form





NATIONAL COMPENSATION SURVEY – Leveling on Duties

and Responsibilities of Supervisor

Schedule Number:




Supervisor

1st 2nd 3rd Line Supervisor/Manager



Quote:


Occupation:






Establishment Grade:


SOC:




Establishment Rate Range:

Establishment Job Title:







Factor

Level

Education, experience, other comments

KNOWLEDGE



JOB CONTROLS AND

COMPLEXITY




CONTACTS




PHYSICAL ENVIRONMENT





Remarks

















U.S. Department of Labor

Bureau of Labor Statistics


National Compensation Survey

Leveling Form




NATIONAL COMPENSATION SURVEY – Leveling Summary

Schedule Number:








Leveling Factors


QUOTE 1

QUOTE 2

QUOTE 3

QUOTE 4

QUOTE 5

QUOTE 6

QUOTE 7

QUOTE 8

KNOWLEDGE











JOB CONTROLS AND

COMPLEXITY










CONTACTS











PHYSICAL ENVIRONMENT













Remarks

























NATIONAL COMPENSATION SURVEY - Work Schedule

Schedule Number:






Quote #

Work Schedule #

Description/occupation

Hours/day

Hours/week

Weeks/year

Type

























































For “Work Schedule #” note also if Alternate work schedule (Only needed for index schedules)








Remarks









































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AuthorCarney, Paul - BLS
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