Attachment 9 - Establishment Info Sheet

OCCUPATIONAL REQUIREMENTS SURVEY (ORS)
GENERAL EST ABLI SHM ENT I NF ORM AT I ON
S CH ED UL E N UM B ER

Type of PSO used: (Standard/Fallback): ______________
Company Name:

Number of Quotes: ___________
Total Employment:

Address:

Name:

Contact 1
Notes:

Title:
Phone:
Email:

Name:

Contact 2
Notes:

Title:
Phone:
Email:
Description of Product/Service:

Facility Type:

Assigned NAICS:
Additional Information:

Actual NAICS:

Private Industry Sample Establishments:
This report is authorized by law, 29 U.S.C. 2. Your voluntary
O.M.B. #1220-0164
cooperation is needed to make the results of this survey
Expires 4/30/15
The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information
comprehensive, accurate, and timely.
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.
We estimate that it will take an average of 60 minutes to complete this interview, 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 Ave 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.

State and Local Government Sample Establishments:
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 the strictest of 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 4/30/15

We estimate that it will take an average of 60 minutes to complete this interview, 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 Ave 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.