Public Employment & Payroll Forms

Attachment 1 E5
2012 CENSUS OF GOVERNMENTS
SURVEY OF PUBLIC EMPLOYMENT & PAYROLL
March 2012 – Municipalities and Townships

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
FORM

E-5

OMB No. 0607-0452: Approval Expires 04/30/2013

(08-29-2011)

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

If you have any questions,
please call 1-800-642-4901
Weekdays, 7am to 5pm EST.
Questions may also be
emailed to:
govs.employ@census.gov
In correspondence
pertaining to this report,
please refer to the User ID
below the address box.

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:
https://respond.census.gov/aspep

1

User ID:
➤
Password:

Is your addressee title/department and mailing address the same as shown in the address label?
Yes – Go to 2

No – Enter correct information below

Addressee Title or Department

Street 1

Street 2

State

City

Zip Code

–

PART 1 – FULL-TIME EMPLOYEES STANDARD WEEKLY HOURS

2

On average, how many hours per week do the majority of your full-time employees work?
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.
• Officials paid on salary basis; by fees or commissions; on a per meeting basis; or a flat sum quarterly,
semi-annually, or annually.
Exclude
• Employees on unpaid leave, unpaid officials, pensioners, and contractors and their employees.

A

40 hours or more

C

34 to 37.4 hours

E

30 to 31.9 hours

B

37.5 to 39.9 hours

D

32 to 33.9 hours

F

No Full-Time Employees

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Mark "X" only one box.

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Attachment 1 E5

Page 2

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS

3

For each applicable pay interval, what were the TOTAL number of employees and TOTAL gross payroll
amounts for the pay periods which include MARCH 12, 2012 for both full-time and part-time employees?
Please also report hours paid for each applicable pay interval for part-time employees.
Include
• Salaries, wages, fees, or commissions.
• Amounts withheld for taxes, employee contributions to retirement systems, etc.
• Persons in paid leave status and persons paid from Federal grant funds.
• Part-time employees working less than the regular, full-time workweek.
• Current employees whether paid from the general fund or special funds.
• All elected or appointed officials who receive any amount of pay or stipend (even small amounts
of $25 per meeting or $100 annually).
• Employees of fee offices should be included in “Financial administration”.
• Include any county supervision of public schools in “All other”.
• If more than three payroll intervals need to be reported, please photocopy the necessary pages
and return them with this form.
Exclude
• Lump sum payments and the value of living quarters and subsistence allowances furnished to employees.
• Any school system employees and payrolls.
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.
Payroll Interval Codes
W = Weekly; B = Bi-Weekly; T = Twice a Month; M = Monthly; Q = Quarterly; S = Semi-Annually; A = Annually

Full-Time Employees

Example
Hospitals – Institutions
for inpatient medical care.
Include all paid student
help . . . . . . . . . . . . . .

TOTAL
Items 1 through 16 . . . .

Payroll
Interval
Codes

Number of
Full-Time
Employees

M

27

$

94500

W

15

$

8250

Part-Time Employees
Payroll
Interval
Codes

Number of
Part-Time
Employees

.00

M

5

$

6000

.00

600

.00

A

2

$

10500

.00

300

Gross Payroll

Hours
Paid

Gross Payroll

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

§4&5;¤

023
1. Financial
administration –
Treasurer’s office, auditor’s
or comptroller’s office, tax
assessing, tax billing and
collection, budgeting,
purchasing, central
accounting offices,
information technology,
and similar financial
administration . . . . . . . . . .
029
2. Central administration –
Council, board of
supervisors or
commissioners; central
administrative officers and
agencies, such as manager
or mayor; clerk; recorder;
zoning; central personnel
agency; and central
planning agency. Exclude
financial activities reported
in Financial
administration and
judicial/legal activities
reported in Judicial
and legal . . . . . . . . . . . . .
025
3. Judicial and legal – All
court and court related
activities, court activities
of sheriff’s office (e.g.,
bailiffs, process servers),
prosecuting attorney’s and
public defender’s offices,
legal department and
attorneys providing
government-wide legal
services. Exclude private
attorneys on retainer and
court appointed attorneys .

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FORM E-5 (08-29-2011)

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A. CENTRAL GOVERNMENT ADMINISTRATION

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Page 3

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS - Continued
Payroll Interval Codes
W = Weekly; B = Bi-Weekly; T = Twice a Month; M = Monthly; Q = Quarterly; S = Semi-Annually; A = Annually

Full-Time Employees
Payroll
Interval
Codes

Number of
Full-Time
Employees

Part-Time Employees
Payroll
Interval
Codes

Gross Payroll

Number of
Part-Time
Employees

Hours
Paid

Gross Payroll

B. PUBLIC SAFETY
4. Police protection – Report police department, law enforcement, activities of sheriff’s and constable’s offices, coroner, etc. Report school crossing guards as
part-time employees.
062

a. Persons with power
of arrest – Report
only police employees
here. Report other
employees with power
of arrest in Judicial
and legal . . . . . . . . . . .

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

162

b. Other police
protection
employees – All police
protection employees
not reported under
Persons with power
of arrest . . . . . . . . . . .

5. Fire protection – Report paid volunteer firefighters as part-time employees; exclude unpaid volunteers. Report separately identifiable rescue squad and
emergency medical services in Health, if they are not a part of the fire department.
024
a. Firefighters –

Persons engaged in
fire suppression and
prevention. Include
employees trained in
these activities but
performing such other
duties as dispatching,
emergency medical
care, etc. . . . . . . . . . . .

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

124

b. Other fire protection
employees –
All fire protection
employees not
included above. . . . . . .

C. TRANSPORTATION
044
6. Streets and highways –
Maintenance, repair,
construction, and
administration of streets,
alleys, sidewalks, roads,
highways, and bridges.
Include engineering
activities and traffic signal
maintenance. Report street
cleaning employees in
Solid waste
management and sewer
employees in Sewerage . .

079
7. Public welfare –
Maintenance of homes and
other institutions for the
needy, nursing homes,
administration of public
assistance and veteran
services, senior citizen and
handicap transportation,
social workers. Report
hospital employees under
Hospitals . . . . . . . . . . . . .
032
8. Health – Public health
services, emergency
medical services, mental
health, alcohol and drug
abuse, outpatient clinics,
visiting nurses, food and
sanitary inspections,
animal control, other
environmental health
activities (e.g., pollution
control), etc. . . . . . . . . . . .

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FORM E-5 (08-29-2011)

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D. SOCIAL SERVICES AND INCOME MAINTENANCE

Attachment 1 E5

Page 4

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS - Continued
Payroll Interval Codes
W = Weekly; B = Bi-Weekly; T = Twice a Month; M = Monthly; Q = Quarterly; S = Semi-Annually; A = Annually

Full-Time Employees
Payroll
Interval
Codes

Number of
Full-Time
Employees

Part-Time Employees
Payroll
Interval
Codes

Gross Payroll

Number of
Part-Time
Employees

Hours
Paid

Gross Payroll

D. SOCIAL SERVICES AND INCOME MAINTENANCE - Continued
036

9. Hospitals – Institutions
for inpatient medical care.
Include all paid student
help. Report nursing home
and welfare institution
employees in Public
welfare. . . . . . . . . . . . . . .

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

E. ENVIRONMENT AND HOUSING
081

10. Solid waste
management –
Street cleaning, recycling,
garbage and refuse
collection and disposal,
operation of sanitary
landfill. . . . . . . . . . . . . . . .
080
11. Sewerage – Provision,
maintenance, and
operation of sanitary and
storm sewer systems and
sewage disposal plants.
Report water supply
employees in Water
supply system . . . . . . . . .
061

12. Parks and recreation –
Parks, playgrounds,
swimming pools,
auditoriums, museums,
marinas, zoos, etc. . . . . . .

F. UTILITIES
091

13. Water supply system –
Public water supply or
distribution system
operated by your
government . . . . . . . . . . . .
092

14. Electric power system –
Public electric power
supply or distribution
system operated by your
government. . . . . . . . . . . .

052

15. Libraries – Public libraries
operated by your
government. Report law
libraries in Judicial and
legal . . . . . . . . . . . . . . . . .

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FORM E-5 (08-29-2011)

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G. OTHER ACTIVITIES

Attachment 1 E5

Page 5

PART 2 – EMPLOYEES, PAYROLL, AND PART-TIME HOURS - Continued
Payroll Interval Codes
W = Weekly; B = Bi-Weekly; T = Twice a Month; M = Monthly; Q = Quarterly; S = Semi-Annually; A = Annually

Full-Time Employees
Payroll
Interval
Codes

Number of
Full-Time
Employees

Part-Time Employees
Payroll
Interval
Codes

Gross Payroll

Number of
Part-Time
Employees

Hours
Paid

Gross Payroll

G. OTHER ACTIVITIES – Continued
089
16. All other – All employees
of your government and
its agencies not reported
elsewhere, except for any
school system employees
and payrolls. Include
employees concerned
with elections and voter
registration, protective
inspection (building,
electrical, etc.), motor
pools, maintenance of
general public buildings,
parking facilities, and
other activities not
reported previously. . . . . .

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

List the major activities reported above in All other.C

a.

b.

c.

d.

e.

f.

PART 3 – REMARKS

4 Use this space to:
a) Explain any significant changes to employment or payroll occurring within the last year that would
aid in understanding this report;
b) Describe any difficulties you encountered in completing this form;
c) List the groups of employees for which you were unable to supply information;
d) Provide contact information for other people who assisted you in completing this report.

PART 4 – CERTIFICATION

Name of person to contact about this report - Please print

Title of person to contact about this report - Please print

Area code and phone number

Area code and fax number

E-mail Address - Please print

Extension

Date form was completed

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, Section 161. 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.
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 11⁄4 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: Paperwork
Project 0607-0452, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to Paperwork@census.gov; use Paperwork Project
0607-0452 as the subject.

FORM E-5 (08-29-2011)

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5 This report is substantially accurate and has been prepared in accordance with the instructions.