NCS SO 1003G Government Benefits Update form

National Compensation Survey

SO-1003G - 2021NCSSOB GOVexample

National Compensation Survey (State and local government sample)

OMB: 1220-0164

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National Compensation Survey Schedule # - 999999

Employment Cost Index

Month Year Update {Index benefits summary only – Government}


Thank you for your assistance with the Employment Cost Index. Your summary of benefits report is enclosed. Please update the plan information and costs within one week of receiving this package. Include any scheduled changes effective before the reference date of MONTH 12, YEAR. If there are significant changes, we may need to follow up with you to get more details.


There are several reporting options available:


Data can be reported in any standard format, but be sure to include your schedule number, 999999, on any reports or emails.

If you have any questions, please contact: XXXX XXXXXXX at 999-999-8888.

Please correct name, title, or address, as needed. Respondent Name

Prepared by: Respondent Title

Name ____________ Company Name

Title ____________ Company Name 2

Telephone: ________________________ Address1

Address2

Date Prepared: City, State Zip


As entered by the regional office





As a participant in a Bureau of Labor Statistics (BLS) statistical survey, you should be aware that use of electronic transmittal methods in reporting data to the BLS involves certain

inherent risks to the confidentiality of those data. Further, you should be aware that responsible electronic transmittal practices employed by the BLS cannot completely eliminate

those risks.


The BLS is committed to the responsible treatment of the data you report and will take appropriate steps within its ability to protect the confidentiality of those data.


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 XXXX

We estimate that it will take an average of 20 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.


(NOTE: This is a computer-generated form that provides prior benefits data to, and requests updated benefits data from survey respondents)

Summary of Benefits (Private Industry) example – update


U. S. DEPARTMENT OF LABOR BUREAU OF LABOR STATISTICS SO-1003P PAGE 1


Establishment = Any Company Schedule Number = XXXXXXX


Mr. Xxxx Xxxxx, CEO

(TEL.) Number


Ben #

Plan description

Expected to change




BENEFIT DESCRIPTIONS COVER THE FOLLOWING OCCUPATIONS

XXXX Division Manager

XXXX Head Technician

XXXX Secretary

XXXX Janitor




01

WORK SCHEDULE – Full-time and part-time



Full-time 8.00 hours/day 40.00/weekly hours 52.0 annual weeks


Part-time 5.00 hours/day 25.00/weekly hours 52.0 annual weeks




01

OVERTIME

1.5X after 40 hours/wk,

2.0X on Sundays





02

VACATION



After 6 months = 1 week



After 1 year = 2 weeks



After 5 years = 3 weeks



After 10 years = 4 weeks (max.)




Summary of Benefits example – update


U. S. DEPARTMENT OF LABOR BUREAU OF LABOR STATISTICS

Establishment = Any Company Schedule Number = XXXXXX


Ben #

Plan description

Expected to change

03

HOLIDAYS



8 paid holidays a year.



New Year’s Day

President’s Day

Memorial Day

July 4th

Labor Day

Veteran’s Day

Thanksgiving

Christmas





04

SICK LEAVE



5 days/year. No carry over.





05

OTHER LEAVE



Auxiliary Leave



Funeral leave: 3 days. Immediate family.



Jury duty: As needed. Unpaid





07

NONPRODUCTION BONUS



Year end bonus: 1 weeks pay.

12/01/XX




10

LIFE INSURANCE



All: $10,000 Life & AD&D. 50% employer paid.

09/01/XX


Total cost: Life = $.70/$1,000/month



AD&D = $.07/$1,000/month



Optional plan 100% employee paid.





11

HEALTH BENEFITS



Blue Cross/Blue Shield

10/31/XX


Eligibility=

3 month LOS, Full-Time



20XX

HEALTH PROVISIONS

EMPLOYER (70%)

EMPLOYEE (30%)



Total cost: Single = $212.34/month





Family = $458.16/month






12

SHORT TERM DISABILITY INSURANCE



Optional plan. 100% employee paid.

10/01/XX

Summary of Benefits example – update


U. S. DEPARTMENT OF LABOR BUREAU OF LABOR STATISTICS

Establishment = Any Company Schedule Number = XXXXX


Ben #

Plan description

Expected to change


PLEASE PROVIDE 20XX RATE


23

LONG TERM DISABILITY PAY

11/01/XX


Full-time:

Benefit = 60% of salary up to $4,000/month until retirement age.

20XX TOTAL COST = $.70/$100 of payroll

Company pays 50%

Employee pays 50%








13

DEFINED BENEFIT PENSION PLANS



Pension plan:

Pays 2.0%X years of service



20XX Fiscal Year:

Co. Cost = $ 189,359.00




Co. gross payroll = $2,310,922.00



Eligibility:

Must work over 1,000 hrs/year.






PLEASE PROVIDE 20XX RATE.


20

STATE UNEMPLOYMENT INSURANCE



20XX rate = 2.4%

10/01/XX




21

WORKER’S COMPENSATION

06/01/XX


20XX Rates




Office 8810 =

$.27/$100.00



Sales workers 8742 =

$.89/$100.00



Experience Modifier =

1.15



Premium Discount =

9.0%










22

THERE ARE NO PROVISIONS FOR THE FOLLOWING BENEFITS:


Defined Contribution Plan





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleNational Compensation Survey
AuthorCarl Prieser
File Modified0000-00-00
File Created2021-11-05

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