Form 790C Fax Form

Page 22 of 22

B ureau of Labor Statistics

U.S Department of Labor

Data Collection Center

dccaddress2

dcccity2, dccst2 dcczip

dccphone2

dccfaxnumber2

February 1, 2021

Attn: Payroll Manager

Con_Firm2

Con_Address

Con_City2, Con_State2 Con_Zipcode2

Dear Payroll Manager:

Thank you for providing your employment, payroll and hours data to the Current Employment Statistics program. Enclosed is your FAX Report Form. Please fill out the form only for the pay period which includes the 12^th of the month and fax it to the telephone number provided by duedate2.

For each worksite with a pre-printed CES report number and worksite description, report all columns for All Workers and Production Workers separately. If the worksite maintains more than one pay frequency, report for the first pay group in Pay Group 1 and for the second in Pay Group 2. If a worksite has more than 2 pay groups, please call the information number for more information. Detailed definitions and instructions are provided on the next page.

Your company was selected as a part of a scientific sample of businesses throughout the United States. The BLS will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act (Title 5 of Public Law 107-347), the information you provide to the BLS will not be disclosed in identifiable form without your informed consent.

If any of the information pre-printed on this form is incorrect or if you have any questions, please contact us at dccphone2.

Sincerely,

signature

dcccntct2

Data Collection Center Manager

This report is authorized by law 29 U.S.C.2. We request your cooperation to make the results of this survey comprehensive accurate, and timely. The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Please note this report is mandatory in North Carolina, under Section 96-4(g) (l) of the North Carolina Employment Security Law; in Oregon, under the Oregon Revised Statute 657.660; in Washington, under the Revised Code of Washington sections 50.12.010, 50.12.070, and 50.12.180; and in South Carolina, under Section 41-29-120 of the Code of Laws of South Carolina (for firms employing more than twenty individuals). Form Approved OMB No. 1220-0011. We estimate that it will take an average of 10 minutes to complete this form each month including time to review instructions, search existing data sources, gather and maintain the necessary data, and complete and review this information. If you have any comments regarding these estimates or any other aspects of this survey, send them to the Bureau of Labor Statistics, Division of Current Employment Statistics (1220-0011), 2 Massachusetts Avenue, NE, Washington, DC 20212. You are not required to respond to the collection of information unless it displays a currently valid OMB control number.

MP MF INT

►Our records show the following information for your firm:

Contact: Attn: Payroll Manager2	Report Number: reptnum
Primary Name	Location: location
address	UI Number:  
city, state zipcode	Industry Code: naics
Tel: con_tel Ext: con_ext
Fax:      	Please fax report to: FAXPHONE3

► Definitions for the Questions on the Next Page

C olumn 1 EMPLOYEE COUNT– ALL WORKERS

Total number of persons in this pay group who worked or received pay for any part of the pay period that includes the 12^th of the month.

Include:		Exclude:
Executives and their staff Full-time and part-time workers Salaried officials of corporations Trainees Workers on active duty, if receiving pay from employer Workers on paid sick leave Workers on paid vacation Workers on other paid leave	Outside contractors and their employees Pensioners Proprietors, owners, or partners of unincorporated firms Workers on active duty, if not receiving  pay from employer Workers on leave without pay for entire pay period Workers on strike for entire pay period Unpaid family members

EMPLOYEE COUNT– Production workers

Number of "All Workers" defined above who are Production Workers. Production Workers include working supervisors or group leaders who may be “in charge” of some employees, but whose supervisory functions are only incidental to their regular work.

Include individuals working in:	Exclude individuals working in:
Assembling Fabricating Janitorial activities Maintenance or repair Materials handling Processing Product development Recordkeeping related to production Shipping or receiving Storage or warehousing Trucking	Accounting or finance Advertising Cafeterias Collection and credit Executive, professional, or technical positions Force account construction Legal Medical Personnel Product installation or servicing Purchasing Recordkeeping not related to production Sales and delivery

Column 2 WOMEN EMPLOYEE COUNT

Number of “All Workers” defined above who are women.

C olumn 3 Payroll, EXCLUDING COMMISSIONS

Total gross pay earned during the entire pay period. Report separately for All Workers and for Production Workers.

Payroll, EXCLUDING COMMISSIONS (continued)

Report pay before employee deductions for:
Taxes FICA (Social Security) Health insurance Pay deferral plans such as 401K	Bonds Pensions Unemployment insurance Union dues
Include:	Exclude:
Wages and salaries Paid holidays, vacation, sick leave, and other paid leave Incentive pay Bonuses paid each pay period Overtime pay Severance, if paid over multiple pay periods	Commissions Annual pay for unused leave Awards or bonuses not paid each pay period Employer contributions to pay such as 401K Pay advances, such as vacation pay advances Payments "in kind" Retroactive or back pay Severance, if provided as one payment Travel or work-related reimbursements

C olumn 4 Commissions

Report separately for “All Workers” and for “Production Workers”.

• Report for the most recent complete period for which commissions are available, which might be different from the pay period that includes the 12th. Enter 0 if none paid for the period or pay group.

• Exclude base pay, drawing accounts, or basic guarantees.

C olumn 5 Hours, INCLUDING OVERTIME

Total number of hours for which employees received pay during the entire pay period. Report separately for All Workers and Production Workers.

• Include overtime; stand-by or reporting time; and hours not worked, but for which workers received pay (holidays, vacations, sick leave, etc.).

• Report hours for salaried and commission-only employees based on their standard work week.

• Do not convert overtime or other premium hours to straight-time equivalent hours.

C olumn 6 Overtime Hours

Total number of hours for which employees received overtime premiums because they worked more than their regularly scheduled hours. Report separately for All Workers and Production Workers.

• Include Saturday, Sunday, 6^th day, 7^th day, and holiday hours.

• Exclude shift differential, hazard, incentive, or similar premiums.

MP MF INT Reference Month/Year: mon1 year1		1	2	3	4	5	6
		Employee Count	Women Employee Count	Payroll, Excluding Commissions (Whole dollars)	Commissions (Whole dollars)	Total Hours, including overtime	Overtime Hours (Whole hours)
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers
Report #: reptnum		State: STC
Pay Group 1	All Workers
	Production Workers
Pay Group 2	All Workers
	Production Workers

Each month report your payroll information for the pay period that includes the 12^th of the month. For questions refer to page 2 for the Column definitions or call the Help Desk at 1-800-827-2005.

790C Feb2011 790CbookFAX.dotx