Form 790S Fax Form

Page 2 of 2

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 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 for All Workers, Women Workers, and Faculty Members. 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 page 2.

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

Column 1 EMPLOYEE COUNT

The total number of persons who worked or received pay for any part of the pay period that includes the 12^th of the month. Include employees who worked only during the school year but received pay for the whole year.

Include:	Exclude:
Counselors, librarians, and coaches Custodial and cafeteria workers Full-time or part-time workers Other non-teaching personnel Paid members of religious orders Students employed on your payroll Teachers, administrators, and trainees Workers on active duty, if receiving pay from employer Workers on paid sick or other leave Workers on paid vacation	Outside contractors and their employees Pensioners School trustees and school board members serving without pay Volunteers Workers on active duty, if not receiving pay from employer Workers on leave without pay for the entire pay period Workers on strike the entire pay period

Column 2 WOMEN EMPLOYEE COUNT

Enter the number of employees from Column 1 who are women.

Column 3 FACULTY MEMBERS

Enter the number of employees from Column 1 who are regular members of the faculty of this institution or school system. Regular members of the faculty are considered to be professional or “certified” employees who have a contractual arrangement (written or otherwise) for one or more years. Faculty Members include principals, teachers, superintendents, administrators, librarians, counselors, and other professional personnel.

MP MF INT

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.

Reference Month/Year: mon1 year1	1	2	3
	Employee Count	Women Employee Count	Faculty Members (Whole dollars)
Report #: reptnum State: STC
Report #: reptnum State: STC
Report #: reptnum State: STC
Report #: reptnum State: STC
Report #: reptnum State: STC
Report #: reptnum State: STC
Report #: reptnum State: STC

790S Feb2011 790SbookFAX.dotx